Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study.
OBJECTIVE
To evaluate the use of remote reading of digital retinal photographs in the diagnosis of severe (referral-warranted) retinopathy of prematurity (ROP) during longitudinal screening for ROP.


METHODS
Prospective, longitudinal cohort study.


METHODS
Forty-four consecutive premature infants at risk for ROP.


METHODS
All infants were examined longitudinally, over a series of examinations, by indirect ophthalmoscopy (gold standard) and digital photography using the RetCam-120 Digital Retinal Camera (Massie Research Laboratories Inc., Dublin, CA) equipped with an ROP lens. Images were stored and read remotely by a masked reader. Referral-warranted ROP was defined as ROP in zone 1, the presence of plus disease or the presence of any stage 3 ROP. We determined whether and when referral-warranted ROP was diagnosed for each eye, of each infant, on each examination, during the course of each of the infant's screening.


RESULTS
Severe (referral-warranted) ROP was diagnosed in 23 eyes by indirect ophthalmoscopy during their series of examinations. Digital photography had a sensitivity of 100% and a specificity of 96% in detecting referral-warranted ROP. The positive predictive value of digital photography was 92%, and the negative predictive value was 100%. In 87% of eyes, referral-warranted ROP was diagnosed by digital photography before or at the same time as indirect ophthalmoscopy.


CONCLUSIONS
Longitudinal remote reading of digital photographs using the RetCam-120 system has excellent specificity and sensitivity in detecting referral-warranted ROP. This pilot study has shown that remote reading of digital photographs has promise for telemedicine strategies in ROP screening.
Department of Ophthalmology, Alberta Children's Hospital, Calgary, Canada.
Anna L
AL
Ells
Jonathan M
JM
Holmes
William F
WF
Astle
Geoff
G
Williams
David A
DA
Leske
Michael
M
Fielden
Brad
B
Uphill
Penny
P
Jennett
Marilynne
M
Hebert
D015331:Cohort Studies; D005189:False Positive Reactions; D005240:Feasibility Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007231:Infant, Newborn; D009887:Ophthalmoscopy; D010781:Photography / Q000379:methods*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019114:Remote Consultation / Q000379:methods*; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012680:Sensitivity and Specificity