Wide-field digital imaging based telemedicine for screening for acute retinopathy of prematurity (ROP). Six-year results of a multicentre field study

Abstract

Objective To report on a 6-year experience with wide-field digital imaging based telemedicine (WFDI telemedicine) to reduce the risk for blindness from retinopathy of prematurity (ROP). Methods Wide-angle digital fundus cameras (RetCam 120, Massie Lab, Pleasanton, CA, USA) were installed in five neonatal intensive care units (NICUs) in Germany. All prematures at risk were screened with WFDI, and the local ophthalmologists were asked to continue binocular indirect ophthalmoscopy (BIO) according to the German guidelines.Image data were coded and transferred to the Reading Centre in Regensburg. Image evaluation and additional BIO of infants with suspected treatment-requiring ROP (STR-ROP i.e. threshold ROP zone II, prethreshold ROP zone I (type-1 ROP according to ETROP), and ROP possibly requiring treatment but not reliably classifiable from the images) were performed by paediatric ophthalmologists at the Reading Centre. ROP was classified following ICROP, ETROP, and revised ICROP criteria. Outcome measures were incidence of clinically relevant ROP (CR-ROP, i.e. any ROP up to mid-peripheral zone III, ≤ stage 3+),

Screening for retinopathy of prematurity

“…Diagnostic accuracy and reliability of remote imaging interpretation by experts would have to be assured. Lorenz et al (2009) reported the success with using wide field digital imaging (RetCam 120) based telemedicine over a six year period where 1,222 infants were screened. They concluded that all treatment requiring retinopathy of prematurity was detected in time with sensitivity for detecting suspected treatment-requiring retinopathy of prematurity at 100% and a positive predictive value for treatment-requiring retinopathy of prematurity 82.4%.…”

Retinopathy of prematurity: a study of incidence and risk factors

“…2 Multiple community-based studies reported positively on the potential for telemedicine screening in remote areas to detect disease that will eventually require treatment. [12][13][14] In a retrospective analysis of the first four years of its telemedicine initiative to screen for retinopathy of prematurity, the Stanford University Network for diagnosis of retinopathy of prematurity reported that none of the infants who needed treatment were missed. 12 Jackson and colleagues found that telemedicine was more cost-effective than standard binocular indirect ophthalmoscopy.…”

Telemedicine for Evaluation of Retinopathy of Prematurity

“…22 In another study, the gold standard indirect ophthalmoscopy examination was not performed on all infants. 23 In the third study, indirect ophthalmoscopy was performed immediately if the photographs indicated referral-warranted ROP (ie, ROP possibly requiring treatment); otherwise, ophthalmoscopy was not performed until discharge. 24 All studies described in the present assessment evaluated detection of any ROP by using wide-angle digital retinal photography (RetCam 120, RetCam II, or RetCam 3; Clarity Medical Systems, Inc, Pleasanton, CA).…”