Smartphone based ROP (S-ROP) screening—opportunities and challenges

Patil, Jayaprakash; Patil, Laxmi; Parachuri, Nikulaa; Kumar, Nilesh; Bandello, Francesco; Kuppermann, Baruch D.; Loewenstein, Anat; Sharma, Ashish

doi:10.1038/s41433-020-0913-1

Cited by 8 publications

(9 citation statements)

References 12 publications

(13 reference statements)

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“…There have been previous evaluations of lower field-of-view cameras for ROP screening . These reports demonstrate that all of these devices, smartphone-based or standalone, can be used for photodocumentation and can capture peripheral pathology under ideal circumstances.…”

Section: Discussionmentioning

confidence: 92%

“…There have been previous evaluations of lower field-ofview cameras for ROP screening. [6][7][8][9][10][11][12][13]22,23 These reports demonstrate that all of these devices, smartphone-based or standalone, can be used for photodocumentation and can capture peripheral pathology under ideal circumstances. Most prior reports display results obtained by ophthalmologists, with or without scleral depression, which may or may not generalize to technician-acquired images in a telescreening program.…”

Section: Discussionmentioning

confidence: 98%

“…The SBFI systems all work according to a similar principle: combining modern, globally available smartphone cameras with standard indirect ophthalmoscopy lenses to provide affordable, portable, noncontact fundus imaging systems. 6,7 SBFI systems have been shown to be beneficial as an adjunct to indirect ophthalmoscopy for bedside documentation of ROP through the Smart ROP initiative in India. [8][9][10] However, most prior reports demonstrate use by trained clinicians.…”

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confidence: 99%

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Efficacy of Smartphone-Based Telescreening for Retinopathy of Prematurity With and Without Artificial Intelligence in India

et al. 2023

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ImportanceRetinopathy of prematurity (ROP) telemedicine screening programs have been found to be effective, but they rely on widefield digital fundus imaging (WDFI) cameras, which are expensive, making them less accessible in low- to middle-income countries. Cheaper, smartphone-based fundus imaging (SBFI) systems have been described, but these have a narrower field of view (FOV) and have not been tested in a real-world, operational telemedicine setting.ObjectiveTo assess the efficacy of SBFI systems compared with WDFI when used by technicians for ROP screening with both artificial intelligence (AI) and human graders.Design, Setting, and ParticipantsThis prospective cross-sectional comparison study took place as a single-center ROP teleophthalmology program in India from January 2021 to April 2022. Premature infants who met normal ROP screening criteria and enrolled in the teleophthalmology screening program were included. Those who had already been treated for ROP were excluded.ExposuresAll participants had WDFI images and from 1 of 2 SBFI devices, the Make-In-India (MII) Retcam or Keeler Monocular Indirect Ophthalmoscope (MIO) devices. Two masked readers evaluated zone, stage, plus, and vascular severity scores (VSS, from 1-9) in all images. Smartphone images were then stratified by patient into training (70%), validation (10%), and test (20%) data sets and used to train a ResNet18 deep learning architecture for binary classification of normal vs preplus or plus disease, which was then used for patient-level predictions of referral warranted (RW)– and treatment requiring (TR)–ROP.Main Outcome and MeasuresSensitivity and specificity of detection of RW-ROP, and TR-ROP by both human graders and an AI system and area under the receiver operating characteristic curve (AUC) of grader-assigned VSS. Sensitivity and specificity were compared between the 2 SBFI systems using Pearson χ2testing.ResultsA total of 156 infants (312 eyes; mean [SD] gestational age, 33.0 [3.0] weeks; 75 [48%] female) were included with paired examinations. Sensitivity and specificity were not found to be statistically different between the 2 SBFI systems. Human graders were effective with SBFI at detecting TR-ROP with a sensitivity of 100% and specificity of 83.49%. The AUCs with grader-assigned VSS only were 0.95 (95% CI, 0.91-0.99) and 0.96 (95% CI, 0.93-0.99) for RW-ROP and TR-ROP, respectively. For the AI system, the sensitivity of detecting TR-ROP sensitivity was 100% with specificity of 58.6%, and RW-ROP sensitivity was 80.0% with specificity of 59.3%.Conclusions and RelevanceIn this cross-sectional study, 2 different SBFI systems used by technicians in an ROP screening program were highly sensitive for TR-ROP. SBFI systems with AI may be a cost-effective method to improve the global capacity for ROP screening.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

mentioning

confidence: 99%

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Efficacy of Smartphone-Based Telescreening for Retinopathy of Prematurity With and Without Artificial Intelligence in India

et al. 2023

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“…Such devices leverage on the smartphone's built-in high-resolution camera, computing power, and data transfer capacities (e.g., Wi-Fi). For low-resource communities and developing countries who face budgetary constraints for the set-up of RDFI-TM programs, smartphone-based imaging tools can be particularly valuable [51].…”

Section: Discussionmentioning

confidence: 99%

The Role of Telemedicine to Alleviate an Increasingly Burdened Healthcare System: Retinopathy of Prematurity

et al. 2020

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Telemedicine-based remote digital fundus imaging (RDFI-TM) offers a promising platform for the screening of retinopathy of prematurity. RDFI-TM addresses some of the challenges faced by ophthalmologists in examining this vulnerable population in both low-and high-income countries. In this review, we studied the evidence on the use of RDFI-TM and analyzed the practical framework for RDFI-TM systems. We assessed the novel technological advances that can be deployed within RDFI-TM systems including noncontact imaging systems, smartphone-based imaging tools, and deep learning algorithms.

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“…A recent adjunct to screening using indirect ophthalmoscopy is image capture using a smartphone; the light source of the phone is used with a condensing lens, and a device can be used to hold the phone if necessary. Despite the images having a narrow field with a limited view of the retina, they can be used to educate parents and neonatal team members, shared on social media to obtain second opinions and serve as a reference to document the findings 14…”

Section: Introductionmentioning

confidence: 99%

Improved screening of retinopathy of prematurity (ROP): development of a target product profile (TPP) for resource-limited settings

et al. 2023

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BackgroundAs more preterm infants survive, complications of preterm birth, including retinopathy of prematurity (ROP), become more prevalent. ROP rates and blindness from ROP are higher in low-income and middle-income countries, where exposure to risk factors can be higher and where detection and treatment of ROP are under-resourced or non-existent. Access to low-cost imaging devices would improve remote screening capabilities for ROP.MethodsTarget product profiles (TPPs) are developed early in the medical device development process to define the setting, target user and range of product requirements. A Delphi-like process, consisting of an online survey and consensus meeting, was used to develop a TPP for an ROP imaging device, collecting feedback on a proposed set of 64 product requirements.ResultsThirty-six stakeholders from 17 countries provided feedback: clinicians (72%), product developers (14%), technicians (6%) and other (8%). Thirty-six per cent reported not currently screening for ROP, with cited barriers including cost (44%), no training (17%) and poor image quality (16%). Among those screening (n=23), 48% use more than one device, with the most common being an indirect ophthalmoscope (87%), followed by RetCam (26%) and smartphone with image capture (26%). Consensus was reached on 53 (83%) product requirements. The 11 remaining were discussed at the consensus meeting, and all but two achieved consensus.ConclusionsThis TPP process was novel in that it successfully brought together diverse stakeholders to reach consensus on the product requirements for an ROP imaging devices. The resulting TPP provides a framework from which innovators can develop prototypes.

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Smartphone based ROP (S-ROP) screening—opportunities and challenges

Cited by 8 publications

References 12 publications

Efficacy of Smartphone-Based Telescreening for Retinopathy of Prematurity With and Without Artificial Intelligence in India

Efficacy of Smartphone-Based Telescreening for Retinopathy of Prematurity With and Without Artificial Intelligence in India

The Role of Telemedicine to Alleviate an Increasingly Burdened Healthcare System: Retinopathy of Prematurity

Improved screening of retinopathy of prematurity (ROP): development of a target product profile (TPP) for resource-limited settings

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