title: Evaluation of an indirect ophthalmoscopy digital photographic system as a retinopathy of prematurity screening tool.
abstract: OBJECTIVE
  To determine whether digital retinal images obtained from an indirect ophthalmoscopy imaging system (Keeler) can be accurately graded for clinically significant retinopathy of prematurity (ROP) by masked experts.
  
  
  METHODS
  The medical records of infants screened for ROP who had posterior pole images acquired using the Keeler system during routine ROP examinations were retrospectively reviewed. Two reviewers, masked to patient demographics and clinical examination findings, graded the images for: (1) quality (good, fair, poor); (2) number of gradable quadrants, from 0 to 4; and (3) posterior pole disease (none, pre-plus, plus). The accuracy of grading Keeler images for clinically significant ROP (defined as pre-plus or plus disease) was compared to results of clinical examination.
  
  
  RESULTS
  One eye each of 253 infants was included. The mean postmenstrual age at examination was 35 weeks (range, 30-42). Grader 1 found the quality of 94% of images to be fair or good; grader 2, 83% of images. Grader 1 judged 87% of images to have ≥3 gradable quadrants; grader 2, 77% of images. The sensitivity and specificity of grading pre-plus or worse disease on Keeler images were 100% and 86%, respectively, for grader 1, and 94% and 89%, respectively, for grader 2.
  
  
  CONCLUSIONS
  Digital retinal images obtained by the Keeler system can be read with high sensitivity and specificity to screen for clinically important ROP. The Keeler system may be a valuable tool for ROP screening at remote locations (ie, via telemedicine).
authors.affiliation: Duke Eye Center, Durham, North Carolina. Electronic address: grace.prakalapakorn@duke.edu.
authors.forename: Sasapin G
authors.initials: SG
authors.lastname: Prakalapakorn
authors.affiliation: Duke Eye Center, Durham, North Carolina.
authors.forename: Sharon F
authors.initials: SF
authors.lastname: Freedman
authors.affiliation: Duke Eye Center, Durham, North Carolina.
authors.forename: David K
authors.initials: DK
authors.lastname: Wallace
mesh_terms: D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening; D009887:Ophthalmoscopy / Q000379:methods*; D010781:Photography / Q000295:instrumentation*; D015203:Reproducibility of Results; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000295:instrumentation*