Survey of Ophthalmology
Volume 54, Issue 6 , Pages 671-685 , November 2009

Telemedicine for Retinopathy of Prematurity Diagnosis: Evaluation and Challenges

  • Grace M. Richter, MD

      Affiliations

    • Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, USA
    • Columbia University Mailman School of Public Health, New York, New York, USA
    • ,
  • Steven L. Williams, MD

      Affiliations

    • Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, USA
    • ,
  • Justin Starren, MD, PhD

      Affiliations

    • Biomedical Informatics Research Center, Marshfield Clinic, Marshfield, Wisconsin, USA
    • Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, New York, USA
    • ,
  • John T. Flynn, MD

      Affiliations

    • Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, USA
    • ,
  • Michael F. Chiang, MD

      Affiliations

    • Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York, USA
    • Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, New York, USA
    • Corresponding Author InformationReprint address: Michael F. Chiang, MD, Herbert Irving Assistant Professor of Ophthalmology and Biomedical Informatics, Columbia University College of Physicians and Surgeons, 635 West 165th Street, Box 92, New York, NY 10032.

References 

  1. Adams GG, Clark BJ, Fang S, Hill M. Retinal haemorrhages in an infant following retcam screening for retinopathy of prematurity. Eye. 2004;18(6):652–653
  2. Azad RV, Chandra P, Pal N, Singh DV. Retinal haemorrhages following retcam screening for retinopathy of prematurity. Eye. 2005;19(11):1221;author reply 1221–2
  3. Balasubramanian M, Capone A, Hartnett ME, et al. The photographic screening for retinopathy of prematurity study (Photo-ROP): study design and baseline characteristics of enrolled patients. Retina. 2006;26(7 Suppl):S4–S10
  4. Balasubramanian M, Capone A, Hartnett ME, et al. The photographic screening for retinopathy of prematurity study (Photo-ROP): primary outcomes. Retina. 2008;28(3):S47–S54
  5. Bashshur RL, Reardon TG, Shannon GW. Telemedicine: a new health care delivery system. Annu Rev Public Health. 2000;21:613–637
  6. Belda S, Pallas CR, De la Cruz J, Tejada P. Screening for retinopathy: is it painful?. Biol Neonate. 2004;86(3):195–200
  7. Castillo-Riquelme MC, Lord J, Moseley MJ, et al. Cost-effectiveness of digital photographic screening for retinopathy of prematurity in the United Kingdom. Int J Technol Assess Health Care. 2004;20(2):201–213
  8. Chen Y, Li X. Characteristics of severe retinopathy of prematurity patients in China: a repeat of the first epidemic?. Br J Ophthalmol. 2006;90(3):268–271
  9. Chen Y, Li X, Yin H, et al. Risk factors for retinopathy of prematurity in six neonatal intensive care units in Beijing, China. Br J Ophthalmol. 2008;92(3):326–330
  10. Chiang MF, Gelman R, Williams SL, et al. Plus disease in retinopathy of prematurity: development of composite images by quantification of expert opinion. Invest Ophthalmol Vis Sci. 2008;49(9):4064–4070
  11. Chiang MF, Jiang L, Gelman R, et al. Interexpert agreement of plus disease diagnosis in retinopathy of prematurity. Arch Ophthalmol. 2007;125(7):875–880
  12. Chiang MF, Keenan JD, Du YE, et al. Assessment of image-based technology: impact of referral cutoff on accuracy and reliability of remote retinopathy of prematurity diagnosis. AMIA Annu Symp Proc. 2005;126–130
  13. Chiang MF, Keenan JD, Starren J, et al. Accuracy and reliability of remote retinopathy of prematurity diagnosis. Arch Ophthalmol. 2006;124(3):322–327
  14. Chiang MF, Starren J, Du YE, et al. Remote image based retinopathy of prematurity diagnosis: a receiver operating characteristic analysis of accuracy. Br J Ophthalmol. 2006;90(10):1292–1296
  15. Chiang MF, Wang L, Busuioc M, et al. Telemedical retinopathy of prematurity diagnosis: accuracy, reliability, and image quality. Arch Ophthalmol. 2007;125(11):1531–1538
  16. Cockey CD. Premature births hit record high. AWHONN Lifelines. 2005;9(5):365–370
  17. Committee for the Classification of Retinopathy of Prematurity . An international classification of retinopathy of prematurity. Arch Ophthalmol. 1984;102:1130–1134
  18. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results. Arch Ophthalmol. 1988;106(4):471–479
  19. Darlow BA, Elder MJ, Horwood LJ, et al. Does observer bias contribute to variations in the rate of retinopathy of prematurity between centres?. Clin Experiment Ophthalmol. 2008;36(1):43–46
  20. Darlow BA, Hutchinson JL, Simpson JM, et al. Variation in rates of severe retinopathy of prematurity among neonatal intensive care units in the Australian and New Zealand Neonatal Network. Br J Ophthalmol. 2005;89(12):1592–1596
  21. Dhaliwal C, Wright E, Graham C, et al. Wide-field digital imaging versus binocular indirect ophthalmoscopy for retinopathy of prematurity screening: a two-observer prospective, randomised comparison. Br J Ophthalmol. 2009;93(3):355–359
  22. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology. 1991;98(5 Suppl):786–806
  23. Early Treatment for Retinopathy of Prematurity Cooperative Group . Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003;121(12):1684–1694
  24. Ells AL, Holmes JM, Astle WF, et al. Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study. Ophthalmology. 2003;110(11):2113–2117
  25. Field MJ. Telemedicine: a guide to assessing telecommunications in healthcare. J Digit Imaging. 1997;10(3 Suppl. 1):28
  26. Gelman R, Jiang L, Du YE, et al. Plus disease in retinopathy of prematurity: pilot study of computer-based and expert diagnosis. J AAPOS. 2007;11(6):532–540
  27. Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev. 2008;84(2):77–82
  28. Gilbert C, Fielder A, Gordillo L, et al. Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: implications for screening programs. Pediatrics. 2005;115(5):e518–e525
  29. Gilbert C, Rahi J, Eckstein M, et al. Retinopathy of prematurity in middle-income countries. Lancet. 1997;350(9070):12–14
  30. Good WV. Final results of the early treatment for retinopathy of prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc. 2004;102:233–248
  31. Good WV, Hardy RJ, Dobson V, et al. Early Treatment for Retinopathy of Prematurity Cooperative Group. The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics. 2005;116(1):15–23
  32. Grabska J, Walden P, Lerer T, et al. Can oral sucrose reduce the pain and distress associated with screening for retinopathy of prematurity?. J Perinatol. 2005;25(1):33–35
  33. Grigsby J, Sanders JH. Telemedicine: where it is and where it's going. Ann Intern Med. 1998;129(2):123–127
  34. Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2005. Natl Vital Stat. 2006;55(11):1–18
  35. Holz FG, Jorzik J, Schutt F, et al. Agreement among ophthalmologists in evaluating fluorescein angiograms in patients with neovascular age-related macular degeneration for photodynamic therapy eligibility (FLAP-study). Ophthalmology. 2003;110(2):400–405
  36. Hussein MA, Coats DK, Paysse EA. Use of the retcam 120 for fundus evaluation in uncooperative children. Am J Ophthalmol. 2004;137(2):354–355
  37. International Committee for the Classification of Retinopathy of Prematurity . The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123(7):991–999
  38. Jackson KM, Scott KE, Graff-Zivin J, et al. Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management. Arch Ophthalmol. 2008;126(4):493–499
  39. Johnson KS, Mills MD, Karp KA, Grunwald JE. Quantitative analysis of retinal vessel diameter reduction after photocoagulation treatment for retinopathy of prematurity. Am J Ophthalmol. 2007;143(6):1030–1032
  40. Johnson KS, Mills MD, Karp KA, Grunwald JE. Semiautomated analysis of retinal vessel diameter in retinopathy of prematurity patients with and without plus disease. Am J Ophthalmol. 2007;143(4):723–725
  41. Joint Working Party of the Royal College of Paediatrics and Child Health the Royal College of Ophthalmologist and the British Association of Perinatal Medicine. A 5 years programme of research into the screening and treatment of retinopathy of prematurity in the UK. London: Royal College of Paediatrics and Child Health; 2002;71
  42. Kaiser RS, Berger JW, Williams GA, et al. Variability in fluorescein angiography interpretation for photodynamic therapy in age-related macular degeneration. Retina. 2002;22(6):683–690
  43. Koreen S, Gelman R, Martinez-Perez ME, et al. Evaluation of a computer-based system for plus disease diagnosis in retinopathy of prematurity. Ophthalmology. 2007;114(12):e59–e67
  44. Koreen S, Lopez R, Jokl DH, et al. Variation in appearance of severe zone 1 retinopathy of prematurity during wide-angle contact photography. Arch Ophthalmol. 2008;126(5):736–737
  45. Krupinski E, Nypaver M, Poropatich R, et al. Telemedicine/telehealth: an international perspective. Clinical applications in telemedicine/telehealth. Telemed J E Health. 2002;8(1):13–34
  46. Kumar H, Nainiwal S, Singha U, et al. Stress induced by screening for retinopathy of prematurity. J Pediatr Ophthalmol Strabismus. 2002;39(6):349–350
  47. Lajoie A, Koreen S, Wang L, et al. Retinopathy of prematurity management using single-image vs. multiple-image telemedicine examinations. Am J Ophthalmol. 2008;146(2):298–309
  48. Laws DE, Morton C, Weindling M, Clark D. Systemic effects of screening for retinopathy of prematurity. Br J Ophthalmol. 1996;80(5):425–428
  49. Lee TC, Lee SW, Dinkin MJ, et al. Chorioretinal scar growth after 810-nanometer laser treatment for retinoblastoma. Ophthalmology. 2004;111(5):992–996
  50. Lorenz B, Spasovska K, Elfein H, Schneider N. Wide-field digital imaging based telemedicine for screening for acute retinopathy of prematurity (ROP). Six-year results of a multicentre field study. Graefes Arch Clin Exp Ophthalmol. 2009;in press
  51. Mackeen L, Ells A. Dynamic documentation of the evolution of retinopathy of prematurity in video format. J AAPOS. 2008;12(4):349–351
  52. Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2005. Natl Vital Stat Rep. 2007;56(6):1–103
  53. Mehta M, Adams GG, Bunce C, et al. Pilot study of the systemic effects of three different screening methods used for retinopathy of prematurity. Early Hum Dev. 2005;81(4):355–360
  54. Mukherjee AN, Watts P, Al-Madfai H, et al. Impact of retinopathy of prematurity screening examination on cardiorespiratory indices: a comparison of indirect ophthalmoscopy and retcam imaging. Am J Ophthalmol. 2006;113(9):1547–1552
  55. Murakami Y, Jain A, Silva R, et al. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) 12-month experience with telemedicine screening. Br J Ophthalmol. 2008;92(11):1456–1460
  56. Ng EYJ, Connolly BP, Mcnamara JA, et al. A comparison of laser photocoagulation with cryotherapy for retinopathy at 10 years, part 1: visual function and structural outcome. Ophthalmology. 2002;109(5):928–934
  57. Palmer EA, Flynn JT, Hardy , et al. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Incidence and early course of retinopathy of prematurity. Ophthalmology. 1991;98(11):1628–1640
  58. Palmer EA, Hardy RJ, Dobson V, et al. 15-year outcomes following threshold retinopathy of prematurity: final results from the multicenter trial of cryotherapy for retinopathy of prematurity. Arch Ophthalmol. 2005;123(3):311–318
  59. Phelps DL. Retinopathy of prematurity: an estimate of vision loss in the United States—1979. Pediatrics. 1981;67(6):924–925
  60. Reynolds JD, Dobson V, Quinn GE, et al. Evidence-based screening criteria for retinopathy of prematurity: natural history data from the CRYO-ROP and LIGHT-ROP studies. Arch Ophthalmol. 2002;120(11):1470–1476
  61. Richter GM, Sun G, Lee TC, et al. Speed of telemedicine vs. Ophthalmoscopy for retinopathy of prematurity diagnosis. Am J Ophthalmol. 2009;in press
  62. Roth DB, Morales D, Feuer WJ, et al. Screening for retinopathy of prematurity employing the retcam 120: sensitivity and specificity. Arch Ophthalmol. 2001;119(2):268–272
  63. Rush R, Rush S, Nicolau J, Chapman K, Nagvi M. Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity. Retina. 2004;24(2):242–245
  64. Rush R, Rush S, Ighani F, et al. The effects of comfort care on the pain response in preterm infants undergoing screening for retinopathy of prematurity. Retina. 2005;25(1):59–62
  65. Schwartz SD, Harrison SA, Ferrone PJ, Trese MT. Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera. Ophthalmology. 2000;107(1):25–28
  66. Scott KE, Kim DY, Wang L, et al. Telemedical diagnosis of retinopathy of prematurity intraphysician agreement between ophthalmoscopic examination and image-based interpretation. Ophthalmology. 2008;115(7):1222–1228
  67. Section on Ophthalmology . American Academy of Pediatrics; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2001;108(3):809–811
  68. Section on Ophthalmology . American Academy of Pediatrics; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2006;117(2):572–576
  69. Shah PK, Narendran V, Saravanan VR, et al. Screening for retinopathy of prematurity—a comparison between binocular indirect ophthalmoscopy and retcam 120. Indian J Ophthalmol. 2006;54(1):35–38
  70. Shennan AH, Bewley S. Why should preterm births be rising?. BMJ. 2006;332(7547):924–925
  71. Silva RA, Murakami Y, Jain A, et al. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) 18-month experience with telemedicine screening. Graefes Arch Clin Exp Ophthalmol. 2009;247(1):129–136
  72. Skalet AH, Quinn GE, Ying GS, et al. Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project. J AAPOS. 2008;12(3):252–258
  73. Slevin M, Murphy JF, Daly L, O'Keefe M. Retinopathy of prematurity screening, stress-related responses, the role of nesting. Br J Ophthalmol. 1997;81(9):762–764
  74. Trese MT. What is the real gold standard for ROP screening?. Retina. 2008;28(3):S1–S2
  75. Vinekar A, Dogra MR, Sangtam T, et al. Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: ten year data from a tertiary care center in a developing country. Indian J Ophthalmol. 2007;55(5):331–336
  76. Wallace DK, Freedman SF, Zhao Z, Jung SH. Accuracy of ROPtool vs individual examiners in assessing retinal vascular tortuosity. Arch Ophthalmol. 2007;125(11):1523–1530
  77. Wallace DK, Quinn GE, Freedman SF, Chiang MF. Agreement among pediatric ophthalmologists in diagnosing plus and pre-plus disease in retinopathy of prematurity. J AAPOS. 2008;12(4):352–356
  78. Wallace DK, Zhao Z, Freedman SF. A pilot study using “ROPtool” to quantify plus disease in retinopathy of prematurity. J AAPOS. 2007;11(4):381–387
  79. Wu C, Petersen RA, VanderVeen DK. Retcam imaging for retinopathy of prematurity screening. J AAPOS. 2006;10(2):107–111
  80. Yen KG, Hess D, Burke B, et al. Telephotoscreening to detect retinopathy of prematurity: preliminary study of the optimum time to employ digital fundus camera imaging to detect ROP. J AAPOS. 2002;6(2):64–70

 The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in the article.

 M.F.C. is supported by a Career Development Award from Research to Prevent Blindness (New York, NY) and by grant EY13972 from the National Institutes of Health (Bethesda, MD). MFC is an unpaid member of the Scientific Advisory Board for Clarity Medical Systems (Pleasanton, CA).

PII: S0039-6257(09)00065-4

doi: 10.1016/j.survophthal.2009.02.020

Survey of Ophthalmology
Volume 54, Issue 6 , Pages 671-685 , November 2009

Article Tools

* Image Usage & Resolution