title: Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project.
abstract: OBJECTIVE
  To determine the feasibility in a middle-level human development country of onsite training, image collection, Internet transfer, and remote grading of digital retinal images from babies screened for retinopathy of prematurity (ROP).
  
  
  METHODS
  Two experienced nurses in a neonatal nursery in Lima, Peru, were trained to take posterior pole (30 degrees ) digital retinal images. Nurses obtained posterior pole retinal images from babies undergoing routine ROP screening and selected images for uploading via Internet for remote evaluation by five masked ROP experts. Results of gradings were compared with same-day clinical diagnostic examinations by an experienced ophthalmologist. Success rates for image acquisition and transfer for grading by expert readers were calculated.
  
  
  RESULTS
  Serial image sets from 26 of the 28 babies enrolled in this study were obtained; two babies were too unstable for imaging. Fifty-six of 58 (96.6%) imaging sessions were successful in obtaining retinal images. Three hundred thirty of 336 (98.2%) images obtained were successfully uploaded to an interactive database. Remote graders judged 93.6% to 97.3% of image sets suitable for ROP grading. Preliminary results indicate sensitivities for detection of serious ROP from 45.5% to 95.2% among individual readers, with specificities of 61.7% to 96.2% when images were gradable.
  
  
  CONCLUSIONS
  A telemedicine approach for ROP screening using digital retinal images obtained by nonophthalmologists is feasible in rapidly developing countries that lack ROP-trained ophthalmologists. If remote grading of digital images is validated as an effective method for identifying referral-warranted ROP (RW-ROP), images obtained by nonphysicians may provide a means of identifying babies who require a diagnostic examination by an ophthalmologist.
authors.affiliation: Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia and Scheie Eye Institute, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Alison H
authors.initials: AH
authors.lastname: Skalet
authors.forename: Graham E
authors.initials: GE
authors.lastname: Quinn
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.forename: Luz
authors.initials: L
authors.lastname: Gordillo
authors.forename: Luz
authors.initials: L
authors.lastname: Dodobara
authors.forename: Ken
authors.initials: K
authors.lastname: Cocker
authors.forename: Alistair R
authors.initials: AR
authors.lastname: Fielder
authors.forename: Anna L
authors.initials: AL
authors.lastname: Ells
authors.forename: Monte D
authors.initials: MD
authors.lastname: Mills
authors.forename: Clare
authors.initials: C
authors.lastname: Wilson
authors.forename: Clare
authors.initials: C
authors.lastname: Gilbert
mesh_terms: D001724:Birth Weight; D003906:Developing Countries; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D015994:Incidence; D007231:Infant, Newborn; D008403:Mass Screening / Q000379:methods*; D009887:Ophthalmoscopy / Q000379:methods*; D010568:Peru / Q000453:epidemiology; D011379:Prognosis; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017216:Telemedicine / Q000379:methods*