Validity of a Telemedicine System for the Evaluation of Acute-Phase Retinopathy of Prematurity

Published on Oct 1, 2014in JAMA Ophthalmology7.389
· DOI :10.1001/JAMAOPHTHALMOL.2014.1604
Graham E. Quinn70
Estimated H-index: 70
(Children's Hospital of Philadelphia),
Gui-Shuang Ying67
Estimated H-index: 67
(UPenn: University of Pennsylvania)
+ 6 AuthorsKelly C. Wade21
Estimated H-index: 21
(Children's Hospital of Philadelphia)
Sources
Abstract
Importance The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy. Objective To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist. Design, Setting, and Participants An observational study of premature infants starting at 32 weeks’ postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013. Interventions Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements. Main Outcomes and Measures The validity of grading retinal image sets was based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination. Results A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2% of eyes (19.4% of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95% CI, 77.4-85.6) and specificity of 90.1% (95% CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0% (95% CI, 85.4-93.5), with specificity of 87.0% (95% CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5% at the observed RW-ROP rate of 19.4%. Conclusions and Relevance When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP. Trial Registration clinicaltrials.gov Identifier:NCT01264276
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Purpose: Detecting sight-threatening retinopathy of prematurity (ROP) relies on a diagnostic examination (DE) performed by an experienced ophthalmologist. An alternative may be a telemedicine system where retinal images of at-risk infants are graded by readers to determine features of ROP indicating the need for a DE. Methods: The multicenter Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) Study is a cohort study of 2000 infants with birth weights 51251 g. At each visit, ophthalmol...
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Abstract Objectives Screening tests are often introduced into clinical practice without proper evaluation, despite the increasing awareness that screening is a double-edged sword that can lead to either net benefits or harms. Our objective was to develop a comprehensive framework for the evaluation of new screening strategies. Study Design and Setting Elaborating on the existing concepts proposed by experts, a stepwise framework is proposed to evaluate whether a potential screening test can be i...
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#1Daniel T Weaver (Billings Clinic)H-Index: 3
#2Todd J. MurdockH-Index: 3
Purpose To demonstrate the feasibility of telemedicine screening for retinopathy of prematurity (ROP) by summarizing the results of our experience screening premature infants at a distant hospital in a rural location. Methods Records of all premature infants remotely screened for ROP at a neonatal intensive care unit in Great Falls, Montana, from January 1, 2007 to June 30, 2011, were retrospectively reviewed. The RetCam II imaging system was used to capture retinal images, which were posted on ...
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Objective To evaluate the accuracy of detecting clinically significant retinopathy of prematurity (ROP) using wide-angle digital retinal photography. Methods Literature searches of PubMed and the Cochrane Library databases were conducted last on December 7, 2010, and yielded 414 unique citations. The authors assessed these 414 citations and marked 82 that potentially met the inclusion criteria. These 82 studies were reviewed in full text; 28 studies met inclusion criteria. The authors extracted ...
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#1Gil Binenbaum (Children's Hospital of Philadelphia)H-Index: 23
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To develop an efficient clinical prediction model that in- cludes postnatal weight gain to identify infants at risk of developing severe retinopathy of prematurity (ROP). Under current birth weight (BW) and gestational age (GA) screening criteria, 5% of infants ex- amined in countries with advanced neonatal care require treatment. PATIENTS AND METHODS: This study was a secondary analysis of pro- spective data from the Premature Infants in Need of Transfusion Study, which enrolled 451 infants wit...
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Background: To evaluate the efficacy of wide-field digital retinal imaging for retinopathy of prematurity screening. Design: Retrospective study in a quaternary public neonatal intensive care unit. Participants: A total of 108 premature infants screened for retinopathy of prematurity. Methods: Retrospective chart and photo review were performed on participants screened by both serial wide-field digital retinal imaging and concurrent binocular indirect ophthalmoscopy. Review of captured digital p...
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Purpose To review findings from the authors' published studies involving telemedicine and image analysis for retinopathy of prematurity (ROP) diagnosis. Methods Twenty-two ROP experts interpreted a set of 34 wide-angle retinal images for presence of plus disease. For each image, a reference standard diagnosis was defined from expert consensus. A computer-based system was used to measure individual and linear combinations of image parameters for arteries and veins: integrated curvature (IC), diam...
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#2Katerina Spasovska (University of Regensburg)H-Index: 1
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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).
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The incidence of retinopathy of prematurity (ROP) continues to rise due to the improved survival of very low birth weight infants in developed countries. This epidemic is also fueled by increased survival of preterm babies with variable use of oxygen and a lack of ROP awareness and screening services in resource-limited regions. Improvements in technology and a basic understanding of the disease pathophysiology have changed the way we screen and manage ROP, educate providers and patients, and im...
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