title: A Comparison of Strategies for Retinopathy of Prematurity Detection.
abstract: OBJECTIVE
  Delayed detection of type 1 retinopathy of prematurity (ROP) can lead to permanent visual impairment. Providing ROP examinations is challenging because of the limited ophthalmology workforce. This study compares digital imaging-based ROP detection strategies versus serial ROP examinations.
  
  
  METHODS
  We conducted an individual-level microsimulation study of a hypothetical cohort of 650 infants with gestational age from 23 to 30 weeks. Infants were evaluated by using strategies based on indirect ophthalmoscopy or digital imaging beginning at 32 weeks' postmenstrual age (PMA) and continuing to discharge, transfer, or 40 weeks' PMA. ROP status and the accuracy of digital imaging were based on the e-ROP (Telemedicine Approaches to Evaluating Acute-Phase ROP) study, which enrolled high-risk infants.
  
  
  RESULTS
  Within the hypothetical NICU, the strategy of ROP examinations identified an average of 45.8 cases of type 1 ROP by discharge, transfer, or 40 weeks' PMA, and another 1.9 cases were included in the group of infants recommended to have later follow-up. Digital imaging with an ROP examination at discharge identified all 47.7 cases of type 1 ROP. On average, the ROP examination-only strategy required 1745.7 ROP examinations, whereas digital imaging with a discharge examination required 1065.5 ROP examinations and 1786.2 digital imaging sessions.
  
  
  CONCLUSIONS
  Although digital imaging decreased the number of ROP examinations per infant, there was an increase in the total number of interventions (ie, ROP examinations and imaging sessions). Providing an ROP examination at the time of NICU discharge can significantly reduce the number of infants who require follow-up.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; alex.kemper@duke.edu.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Kemper
authors.affiliation: Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan;
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Wade
authors.affiliation: Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland;
authors.forename: Michael X
authors.initials: MX
authors.lastname: Repka
authors.affiliation: Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, Philadelphia, Pennsylvania; and.
authors.forename: Gui-shuang
authors.initials: GS
authors.lastname: Ying
authors.affiliation: Division of Pediatric Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Agnieshka
authors.initials: A
authors.lastname: Baumritter
authors.affiliation: Division of Pediatric Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Graham E
authors.initials: GE
authors.lastname: Quinn
mesh_terms: D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000379:methods; D012178:Retinopathy of Prematurity / Q000175:diagnosis*