Variation in Appearance of Severe Zone 1 Retinopathy of Prematurity During Wide-angle Contact Photography

Koreen, Susan; Lopez, Robert; Jokl, Danny H.-Kauffmann; Flynn, John T.; Chiang, Michael F.

doi:10.1001/archopht.126.5.736

Cited by 19 publications

(17 citation statements)

References 4 publications

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“…Second, identifying the clinical features of ROP in zone I are often subtle, in particular flat stage 3 ROP, and challenge clinicians who manage ROP. 13–15 The retinopathy may have been apparent on the image but incorrectly interpreted by TRs. Finally, at least 2 of the G−/E+ cases could have been avoided if the threshold for rating an image set as “not gradable” was lower, which would have designated those image sets as having RW-ROP.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

et al. 2016

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IMPORTANCEAs effective treatments for potentially blinding retinopathy of prematurity (ROP) have been introduced, the importance of consistency in findings has increased, especially with the shift toward retinal imaging in infants at risk of ROP.OBJECTIVE To characterize discrepancies in findings of ROP between digital retinal image grading and examination results from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity study, conducted from May 2011 to October 2013. DESIGN, SETTING, AND PARTICIPANTSA poststudy consensus review of images was conducted by 4 experts, who examined discrepancies in findings between image grades by trained nonphysician readers and physician examination results in infants with referral-warranted ROP (RW-ROP). Images were obtained from 13 North American neonatal intensive care units from eyes of infants with birth weights less than 1251 g. For discrepancy categories with more than 100 cases, 40 were randomly selected; in total, 188 image sets were reviewed. MAIN OUTCOMES AND MEASURESConsensus evaluation of discrepant image and examination findings for RW-ROP components. RESULTS Among 5350 image set pairs, there were 161 instances in which image grading did not detect RW-ROP noted on clinical examination (G−/E+) and 854 instances in which grading noted RW-ROP when the examination did not (G+/E−). Among the sample of G−/E+ cases, 18 of 32 reviews (56.3%) agreed with clinical examination findings that ROP was present in zone I and 18 of 40 (45.0%) agreed stage 3 ROP was present, but only 1 of 20 (5.0%) agreed plus disease was present. Among the sample of G+/E− cases, 36 of 40 reviews (90.0%) agreed with readers that zone I ROP was present, 23 of 40 (57.5%) agreed with readers that stage 3 ROP was present, and 4 of 16 (25.0%) agreed that plus disease was present. Based on the consensus review results of the sampled cases, we estimated that review would agree with clinical examination findings in 46.5% of the 161 G−/E+ cases (95% CI, 41.6-51.6) and agree with trained reader grading in 70.0% of the 854 G+/E− cases (95% CI, 67.3-72.8) for the presence of RW-ROP.CONCLUSIONS AND RELEVANCE This report highlights limitations and strengths of both the remote evaluation of fundus images and bedside clinical examination of infants at risk for ROP. These findings highlight the need for standardized approaches as ROP telemedicine becomes more widespread.

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Section: Discussionmentioning

confidence: 99%

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

et al. 2016

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“…A previous report described an apparent change in peripheral ROP associated with excessive pressure of the camera lens. 27 Therefore, excellent communication must exist between on-site NICU screening staff and remotely located screening physicians. Periodic site visits have been helpful in maintaining both continuity of care and open lines of communication during our nearly 5-year experience.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine detection of type 1 ROP in a distant neonatal intensive care unit

Weaver

Murdock²

2012

Journal of American Association for Pediatric Ophthalmology and

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“…A case report in the ophthalmology literature 34 clearly illustrates this point: a photograph showing only immature vascularization in zone I was followed by a second photograph of the same field taken 10 minutes later, which showed stage 3 disease present in zone I. The authors hypothesized that the difference in results was attributable to the application of excessive pressure on the photographic contact device when the first photograph was taken.…”

Section: Trainingmentioning

confidence: 99%

Telemedicine for Evaluation of Retinopathy of Prematurity

Fierson¹,

Capone²,

Granet³

et al. 2015

Pediatrics

145

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Retinopathy of prematurity (ROP) remains a significant threat to vision for extremely premature infants despite the availability of therapeutic modalities capable, in most cases, of managing this disorder. It has been shown in many controlled trials that application of therapies at the appropriate time is essential to successful outcomes in premature infants affected by ROP. Bedside binocular indirect ophthalmoscopy has been the standard technique for diagnosis and monitoring of ROP in these patients. However, implementation of routine use of this screening method for at-risk premature infants has presented challenges within our existing care systems, including relative local scarcity of qualified ophthalmologist examiners in some locations and the remote location of some NICUs. Modern technology, including the development of wide-angle ocular digital fundus photography, coupled with the ability to send digital images electronically to remote locations, has led to the development of telemedicine-based remote digital fundus imaging (RDFI-TM) evaluation techniques. These techniques have the potential to allow the diagnosis and monitoring of ROP to occur in lieu of the necessity for some repeated on-site examinations in NICUs. This report reviews the currently available literature on RDFI-TM evaluations for ROP and outlines pertinent practical and risk management considerations that should be used when including RDFI-TM in any new or existing ROP care structure.

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Variation in Appearance of Severe Zone 1 Retinopathy of Prematurity During Wide-angle Contact Photography

Cited by 19 publications

References 4 publications

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

Telemedicine detection of type 1 ROP in a distant neonatal intensive care unit

Telemedicine for Evaluation of Retinopathy of Prematurity

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