DEC 01, 2014
Pediatric Ophth/Strabismus, Retina/Vitreous
This large, multicenter, National Eye Institute-funded study of premature infants found that a telemedicine system can effectively screen for ROP.
The authors compared remote evaluations of digital images to the findings of a criterion-standard indirect ophthalmoscopic examination performed by experienced ophthalmologists. Subjects included 1,257 infants with birth weight less than 1251 g and born, on average, at 27 weeks of gestational age in neonatal intensive care units in 13 North American centers.
Ophthalmologists conducted eye examinations and documented referral-warranted ROP (RW-ROP; defined as zone I ROP, stage 3 ROP or worse, or plus disease) or exam findings suggestive of high risk for ROP about every nine days. Trained non-physician image readers then downloaded images and independently evaluated them following a standard protocol, and reported the presence or absence of RW-ROP.
Sensitivity for detection of RW-ROP was 81.9%, with a specificity of 90.1%. When both eyes of an infant were considered, the sensitivity increased to 90.0%, with specificity of 87.0%, negative predictive value of 97.3%, and positive predictive value of 62.5% at the observed RW-ROP rate of 19.4%. Importantly, among infants treated for ROP, the sensitivity of image grading increased to 98.2%.
They conclude that this telemedicine system is valid in managing ROP with the ability to accurately rule out referral-warranted ROP in over 97% of infants. It might be possible to implement safeguards, such as weight-pattern algorithms and more frequent imaging, to catch the small number of infants whose image grading does not detect referral-warranted ROP.