Retinopathy Of Prematurity Care Research Articles

Implementation of Artificial Intelligence in Retinopathy of Prematurity Care: Challenges and Opportunities.

The diagnosis of retinopathy of prematurity (ROP) is primarily image-based and suitable for implementation of artificial intelligence (AI) systems. Increasing incidence of ROP, especially in low and middle-income countries, has also put tremendous stress on health care systems. Barriers to the implementation of AI include infrastructure, regulatory, legal, cost, sustainability, and scalability. This review describes currently available AI and imaging systems, how a stable telemedicine infrastructure is crucial to AI implementation, and how successful ROP programs have been run in both low and middle-income countries and high-income countries. More work is needed in terms of validating AI systems with different populations with various low-cost imaging devices that have recently been developed. A sustainable and cost-effective ROP screening program is crucial in the prevention of childhood blindness.

Regional variations in retinopathy of prematurity incidence for preterm infants

ObjectivesNational-level data on the incidence of retinopathy of prematurity (ROP) in different regions of China is insufficient. This study aimed to compare ROP incidences and care practices in different regions of China and their relationship with regional gross domestic product (GDP) per capita. Study designRetrospective cohort study. MethodsAll infants born at <32 weeks gestational age (GA) and admitted to 70 neonatal intensive care units (NICUs) from January 1, 2019, to December 31, 2020, were enrolled. Hospitals were categorised into three regional groups according to geographical locations and GDP per capita from high to low: Eastern, Central, and Western China. The incidence of death or ROP, and care practices were compared among the groups. ResultsA total of 18,579 infants were enrolled. Median GA was 29.9 (interquartile range 28.4–31.0) weeks and birth weight was 1318.1 (317.2) g. The percentage of GA <28 weeks, complete administration of antenatal steroids, and weight gain velocity during NICU stay were highest in Eastern China and lowest in Western China (all P < 0.01). In Eastern, Central, and Western China, the rates of death or any stage of ROP were 33.3%, 38.5%, and 39.2%, respectively (P < 0.01). ConclusionsThere were considerable regional disparities in ROP incidence in preterm infants with GA <32 weeks in China. The incidence of death or ROP ranged from high to low in Western, Central, and Eastern China.

Trends in Retinopathy of Prematurity Care in the United States 2009–2018: A Nationwide Analysis Using National Inpatient Sample

Retinopathy of prematurity (ROP) represents a leading cause of childhood blindness. The purpose of our study was to evaluate incidence, trends in cost and length of hospital stay, and risk factors for ROP using a publicly available population-based dataset, the National Inpatient Sample. This cross-sectional study analyzed data from 2009 to 2018 using the National Inpatient Sample. Premature neonates (n= 717 277) who met the screening criteria for ROP with gestational age of ≤ 30 weeks or birthweight (BW) of ≤ 1500 g were identified. Database analysis. Incidence, demographics, risk factors for ROP development, trends in cost, and length of stay were evaluated. In total, incidence of ROP increased from 11% in 2009 to 15% in 2018 (P < 0.001). Multivariate logistic regression model of ROP development showed its associations with female sex (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.10-1.17), Hispanic (OR, 1.10; 95% CI, 1.03-1.18), and Black (OR, 0.91; 95% CI 0.86-0.96) ethnicity. Neonates with lower BWs, particularly those in the 500- to 999-g subgroup (OR, 2.64; 95% CI, 2.44-2.85) and younger gestational ages, particularly those born between 25 and 28 weeks gestational age (OR, 2.41; 95% CI, 2.25-2.58), had increased risk of developing ROP. Comorbidities associated with the development of ROP were perinatal jaundice (OR, 1.84; 95% CI, 1.74-1.94), patent ducts arteriosus (OR, 1.67; 95% CI, 1.60-1.75), intraventricular hemorrhage (OR, 1.41; 95% CI, 1.35-1.48), perinatal infection (OR, 1.84; 95% CI, 1.74-1.94), and respiratory distress syndrome (OR, 1.05; 95% CI, 1.01-1.10). Retinopathy of prematurity develops in about 1 of 10 premature infants and incidence has been shown to be increasing. Significant risk factors were female sex, Hispanic ethnicity, lower BW, younger gestational age, and systemic comorbidities, including perinatal jaundice, patent ductus arteriosus, intraventricular hemorrhage, perinatal sepsis, and respiratory distress syndrome. Proprietary or commercial disclosure may be found after the references.

Evaluation of a revised care plan for babies with retinopathy of prematurity during SARS-CoV-2 pandemic in India.

Purpose:To analyze the impact of a revised care plan for retinopathy of prematurity (ROP) during SARS-CoV-2 pandemic in a tertiary eye care facility in eastern India.Methods: In a retrospective study, we analyzed the medical records of babies managed for ROP during the peak of the SARS-CoV-2 pandemic, with particular reference to the challenges, and the revised strategies addressing travel restrictions for five months, from April to August 2020. The strategy included selective referral (babies with higher treatment probability), longer follow-up intervals (babies with non-alarming findings), use of locally available workforce, and teleconsultation whenever feasible.Results: In the given period, 222 babies were examined versus 624 in the preceding year (P = 0.001). The average gestational age, birth weight, and postmenstrual age at presentation were 30.4 weeks, 1.31 kg, and 37.7 weeks, respectively. The first examination was on time in 40.1% of babies but was delayed by a median of 23 days in the remaining babies. In the cohort, 56.7% of babies had any ROP, and 27.9% required treatment (versus 8.8% in the previous year; P < 0.001). The intravitreal anti–vascular growth factor (anti-VEGF) injection was more often used than in the previous year (n = 72 vs 36; P < 0.0001). The treatment outcome was comparable before and after the SARS-CoV-2 lockdown period. There was no report of health issues among the care providers attributable to ROP care.Conclusion: The revised strategy resulted in a smaller pool of babies screened but a larger proportion of babies treated for ROP. This strategy could be used more profitably in future ROP care.

Assessment and management of retinopathy of prematurity in the era of anti-vascular endothelial growth factor (VEGF).

The incidence of retinopathy of prematurity (ROP) continues to rise due to the improved survival of very low birth weight infants in developed countries. This epidemic is also fueled by increased survival of preterm babies with variable use of oxygen and a lack of ROP awareness and screening services in resource-limited regions. Improvements in technology and a basic understanding of the disease pathophysiology have changed the way we screen and manage ROP, educate providers and patients, and improve ROP awareness. Advancements in imaging techniques, expansion of telemedicine services, and the potential for artificial intelligence-assisted ROP screening programs have created opportunities to improve ROP care in areas with a shortage of ophthalmologists trained in ROP. To address the gap in provider knowledge regarding ROP, the Global Education Network for Retinopathy of Prematurity (GEN-ROP) created a web-based tele-education training module that can be used to educate all providers involved in ROP, including non-physician ROP screeners. Over the past 50 years, the treatment of severe ROP has evolved from limited treatment modalities to cryotherapy and laser photocoagulation. More recently, there has been growing evidence to support the use of anti-vascular endothelial growth factor (VEGF) agents for the treatment of severe ROP. However, VEGF is known to be important in organogenesis and microvascular maintenance, and given that intravitreal anti-VEGF treatment can result in systemic VEGF suppression over a period of at least 1-12 weeks, there are concerns regarding adverse effects and long-term ocular and systemic developmental consequences of anti-VEGF therapy. Future research in ophthalmology to address the growing burden of ROP should focus on cost-effective fundus imaging devices, implementation of artificial intelligence platforms, updated treatment algorithms with optimal use of anti-VEGF and careful investigation of its long-term effects, and surgical options in advanced ROP. Addressing these unmet needs will aid the global effort against the ROP epidemic and optimize our understanding and treatment of this blinding disease.

Health Equity and Disparities in ROP Care: A Need for Systematic Evaluation.

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder that can have devastating visual sequelae if not managed appropriately. From an ophthalmology standpoint, ROP care is complex, since it spans multiple care settings and providers, including those in the neonatal intensive care unit (NICU), step down nurseries, and the outpatient clinic setting. This requires coordination and communication between providers, ancillary staff, and most importantly, effective communication with the patient's family members and caregivers. Often, factors related to the social determinants of health play a significant role in effective communication and care coordination with the family, and it is important for ophthalmologists to recognize these risk factors. The aim of this article is to (1) review the literature related to disparities in preterm birth outcomes and infants at risk for ROP; (2) identify barriers to ROP care and appropriate follow up, and (3) describe patient-oriented solutions and future directions for improving ROP care through a health equity lens.

Cost-effectiveness of Artificial Intelligence–Based Retinopathy of Prematurity Screening

Artificial intelligence (AI)-based retinopathy of prematurity (ROP) screening may improve ROP care, but its cost-effectiveness is unknown. To evaluate the relative cost-effectiveness of autonomous and assistive AI-based ROP screening compared with telemedicine and ophthalmoscopic screening over a range of estimated probabilities, costs, and outcomes. A cost-effectiveness analysis of AI ROP screening compared with ophthalmoscopy and telemedicine via economic modeling was conducted. Decision trees created and analyzed modeled outcomes and costs of 4 possible ROP screening strategies: ophthalmoscopy, telemedicine, assistive AI with telemedicine review, and autonomous AI with only positive screen results reviewed. A theoretical cohort of infants requiring ROP screening in the United States each year was analyzed. Screening and treatment costs were based on Current Procedural Terminology codes and included estimated opportunity costs for physicians. Outcomes were based on the Early Treatment of ROP study, defined as timely treatment, late treatment, or correctly untreated. Incremental cost-effectiveness ratios were calculated at a willingness-to-pay threshold of $100 000. One-way and probabilistic sensitivity analyses were performed comparing AI strategies to telemedicine and ophthalmoscopy to evaluate the cost-effectiveness across a range of assumptions. In a secondary analysis, the modeling was repeated and assumed a higher sensitivity for detection of severe ROP using AI compared with ophthalmoscopy. This theoretical cohort included 52 000 infants born 30 weeks' gestation or earlier or weighed 1500 g or less at birth. Autonomous AI was as effective and less costly than any other screening strategy. AI-based ROP screening was cost-effective up to $7 for assistive and $34 for autonomous screening compared with telemedicine and $64 and $91 compared with ophthalmoscopy in the primary analysis. In the probabilistic sensitivity analysis, autonomous AI screening was more than 60% likely to be cost-effective at all willingness-to-pay levels vs other modalities. In a second simulated cohort with 99% sensitivity for AI, the number of late treatments for ROP decreased from 265 when ROP screening was performed with ophthalmoscopy to 40 using autonomous AI. AI-based screening for ROP may be more cost-effective than telemedicine and ophthalmoscopy, depending on the added cost of AI and the relative performance of AI vs human examiners detecting severe ROP. As AI-based screening for ROP is commercialized, care must be given to appropriately price the technology to ensure its benefits are fully realized.

Multimodal Imaging, Tele-Education, and Telemedicine in Retinopathy of Prematurity.

Retinopathy of prematurity (ROP) is a disease that affects retinal vasculature in premature infants and remains one of the leading causes of blindness in childhood worldwide. ROP screening can encounter some difficulties such as the lack of specialists and services in rural areas. The evolution of technology has helped address these issues and led to the emergence of state-of-the-art multimodal digital imaging devices such fundus cameras with its variable properties, optical coherence tomography (OCT), OCT angiography, and fluorescein angiography which has helped immensely in the process of improving ROP care and understanding the disease pathophysiology. Computer-based imaging analysis and deep learning have recently been demonstrating promising outcomes in regard to ROP diagnosis. Telemedicine is considered an acceptable alternative to clinical examination when optimal circumstances for ROP screening in certain areas are lacking, and the expansion of these programs has been reported. Tele-education programs in ROP have the potential to improve the quality of training to physicians to optimize ROP care.

Cost-Utility Analysis of Wide-Field Imaging as an Auxiliary Technology for Retinopathy of Prematurity Care in Brazil.

Purpose: To evaluate the cost–utility of wide-field imaging (WFI) as a complementary technology for retinopathy of prematurity (ROP) screening from the Brazilian Unified Health System's perspective.Introduction: ROP is one of the leading causes of avoidable childhood blindness worldwide, especially in middle-income countries. The current ROP screening involves indirect binocular ophthalmoscopy (IBO) by ROP expert ophthalmologists. However, there is still insufficient ROP screening coverage. An alternative screening strategy is the combination of WFI with IBO.Methods: A cost–utility analysis was performed using a deterministic decision-tree simulation model to estimate incremental cost–utility for ROP care. Two screening strategies were compared: (1) IBO and (2) combination of WFI of all eligible preterm infants and IBO for type 2 ROP or worse and for non-readable images. Eligible population included preterm infants <32 weeks of gestational age or birth weight equal to or <1,500 g. The temporal horizon was lifetime. Visual outcome data was converted to utility, and the health benefits were estimated on quality-adjusted life-years (QALY). Incremental cost per QALY gained was calculated from the health system perspective. Costs were estimated considering equipment, maintenance, consumables, and staff. A micro-costing approach was used for WFI. Two technician nurses were trained for imaging execution and had their time evaluated. Two ROP expert ophthalmologists had their time evaluated for imaging reading. One-way sensitivity analysis and probabilistic sensitivity analysis were performed.Results: Combined screening strategy resulted in a cost-effective program considering 90% ROP screening coverage. Costs per examination: (1) screening with IBO: US dollar (US $) 34.36; (2) screening with combination: US $58.20; (3) laser treatment: US $642.09; (4) long-term follow-up: ranged from US $69.33 to 286.91, based on the infant's visual function. Incremental cost per QALY gained was US $1,746.99/QALY per infant screened with the combination strategy. One-way sensitivity analysis resulted in cost-effectiveness for all parameters. Probabilistic sensitivity analyses yielded a 100% probability of combination being cost-effective in a willingness-to-pay threshold of US $1,800/QALY.Conclusion: The combined strategy for ROP screening was cost-effective. It enhances access for appropriate ROP care in middle-income countries and dminishes opportunity costs for ophthalmologists.

Development of 3D Printed Smartphone-Based Multi-Purpose Fundus Camera (MultiScope) for Retinopathy of Prematurity

Retinopathy of Prematurity (ROP) is a prominent source of low vision and blindness in preterm babies. Wide-Field Digital Retinal Imaging (WFDRI) systems acquire accurate digital images which are very useful for identification, documentation and transmitting the various retinal diseases. This telemedicine technique has potential for an alternative tool for Binocular Indirect Ophthalmoscopy(BIO) in ROP screening, but it is very expensive and accessibility for poor communities is limited. Capabilities of good illumination, high resolution camera and processing speed of the modern smartphones are being identified as a substitute. Potential applications of 3D printing is that it provides a severe impact in medical field, especially in ophthalmology sector. Competences of 3D printing are very useful for the development of retinal camera from any smartphone with the help of 3D printable devices. The primary aim of this study is to develop a handheld 3D printed smartphone-based multi-purpose fundus camera for ROP screening. The secondary aim is to check the feasibility and compare the digital fundus images obtained from the developed fundus camera against the commercial RetCam imaging. The proposed cost effective and remote reading device is an alternative to WFDRI for ROP screening and can improve the potential of ROP care for low resource communities.

Improving Retinopathy of Prematurity Care: A Medico-Legal Perspective.

Retinopathy of prematurity (ROP) is the leading cause of preventable infant blindness in the world. India leads all nations with the highest number of premature infants born each year. Asia has the highest estimated incidence, where visual loss from ROP is over twice as high per million live births compared to established market economies. The problems of ROP management in these countries are compounded by a large cohort of babies who require screening, relatively few ROP specialists, and more recently medico-legal challenges. The authors share the Indian jurisprudence literature from the past decade relating to ROP, summarizing key clinical lessons learned from these legal judgments. The authors endeavor to enlist good clinical practices for various key steps involved in ROP care to help mitigate future litigations as well as protect the clinical interest of the infants who require ROP screening and treatment.

Socioeconomics of retinopathy of prematurity screening and treatment in the United States

Retinopathy of prematurity (ROP) screening, an integral part of pediatric ophthalmology, can be time consuming and resource intensive. The purpose of this study was to evaluate the economic landscape of ROP screening and treatment among pediatric ophthalmologists in the United States.An online survey was distributed to US pediatric ophthalmologists through a pediatric ophthalmology email listserv. Survey results were compiled, and responses were deidentified and analyzed, with particular focus on factors affecting financial compensation.A total of 97 responses were collected. Almost half of respondents worked in private practice settings. Over 80% of respondents had a formal contract to perform ROP care, but only 26% enlisted the assistance of an attorney to negotiate their contract. Just over half of respondents believed themselves adequately compensated for their services. Respondents that had retained an attorney for contractual negotiations were more likely to have a higher mean annual compensation rate ($126,545 ± $145,133 vs $70,214 ± $50,671; P = 0.05). Physicians who believed themselves adequately compensated were more likely to be in academic practice settings (78% academic vs 55% combo/other vs 24% private; P < 0.001) and were more likely to have contracts to perform ROP care (68% with contracts vs 15% without; P = 0.001). Average annual compensation was $82,968 ± $84,132, approximately $24,000 higher than reported in 2013.More pediatric ophthalmologists among our respondents obtained contracts for their services, and compensation rates have increased since 2013. Nevertheless, concerns regarding under-compensation and time commitment persist, raising concerns about the long-term sustainability of current models for providing ROP services.

International Classification of Retinopathy of Prematurity, Third Edition

The International Classification of Retinopathy of Prematurity is a consensus statement that creates a standard nomenclature for classification of retinopathy of prematurity (ROP). It was initially published in 1984, expanded in 1987, and revisited in 2005. This article presents a third revision, the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), which is now required because of challenges such as: (1) concerns about subjectivity in critical elements of disease classification; (2) innovations in ophthalmic imaging; (3) novel pharmacologic therapies (e.g., anti-vascular endothelial growth factor agents) with unique regression and reactivation features after treatment compared with ablative therapies; and (4) recognition that patterns of ROP in some regions of the world do not fit neatly into the current classification system. Review of evidence-based literature, along with expert consensus opinion. International ROP expert committee assembled in March 2019 representing 17 countries and comprising 14 pediatric ophthalmologists and 20 retinal specialists, as well as 12 women and 22 men. The committee was initially divided into 3 subcommittees-acute phase, regression or reactivation, and imaging-each of which used iterative videoconferences and an online message board to identify key challenges and approaches. Subsequently, the entire committee used iterative videoconferences, 2 in-person multiday meetings, and an online message board to develop consensus on classification. Consensus statement. The ICROP3 retains current definitions such as zone (location of disease), stage (appearance of disease at the avascular-vascular junction), and circumferential extent of disease. Major updates in the ICROP3 include refined classification metrics (e.g., posterior zone II, notch, subcategorization of stage 5, and recognition that a continuous spectrum of vascular abnormality exists from normal to plus disease). Updates also include the definition of aggressive ROP to replace aggressive-posterior ROP because of increasing recognition that aggressive disease may occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources. ROP regression and reactivation are described in detail, with additional description of long-term sequelae. These principles may improve the quality and standardization of ROP care worldwide and may provide a foundation to improve research and clinical care.

Retinopathy of prematurity screening and risk mitigation during the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted the delivery of healthcare. Although most nonurgent ophthalmology visits at Boston Children's Hospital were canceled, premature infants at risk for retinopathy of prematurity (ROP) still required timely, in-person care during the initial 3-month period of the infection surge in Massachusetts. The purpose of the current study was to report our protocols for mitigating risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between infants and eye care providers and to compare examination rates and results with the same 3-month period in 2019.MethodsDuring the infection surge, we added new infection control measures and strengthened existing ones. Additional personal protective equipment was used, and the number of ophthalmologists rotating in the three high-capacity NICUs we service was limited.ResultsMore infants required ROP examinations during the study period in 2020 than in the same period in 2019, but fewer examinations were performed. There were no cases of missed progression to severe ROP during this time and no known transmission of SARS-CoV-2 between ROP patients and ophthalmology staff.ConclusionsOverall, effective ROP care was safely provided during the COVID-19 pandemic, and contact with this vulnerable population was minimized.

Commentary: "Indovation" in retinopathy of prematurity management during COVID-19 times.

The coronavirus disease-2019 (COVID-19) pandemic has caught many of us off-guard and thrust even the most developed of nations into chaos. While the direct implications of the disease have been much talked about, the collateral damage on patients suffering from non-COVID conditions has been equally severe. Retinopathy of prematurity (ROP) is an ocular emergency and any delay in treatment leads to permanent visual loss in a premature child. However, during the COVID-19 pandemic, lesser number of ROP babies got screened with an increasing proportion of them presenting with advanced disease.[1] Despite effective methods of treatment with laser and surgery, many premature neonates lost vision in the initial days of the COVID-19 lockdown due to late presentation.[23] To add to this, the fear of COVID-19 transmission led various doctors to reduce working hours, taking ROP care further away from those in need of it. In these testing times, Nayak et al.[4] have come out with a unique 'indovation' – The virus containment box. The basic concept stems from an incubator where ROP screening and laser are provided through the visualization provided by the slanting wall of the incubator.[5] The authors have described a low-cost setup that may be feasible at the level of a general ophthalmologist. While the authors must be applauded for their effort, a little note of caution is necessary here. Pros and Cons of Barrier Devices Barrier devices have become a commonplace due to the circumstances of the COVID-19 pandemic. Various designs of barrier devices for procedures such as mechanical intubation/resuscitation have been published over the past few months.[6789] Some devices even incorporate a negative pressure system to actively eliminate any aerosols that may be generated during the procedure. However, the impact of aerosols generated by a crying baby may not be completely gauged by the 'eye drop bottle' experiment applied by Nayak et al.[4] An airborne particle counter with a laser diode and photon detector to detect various sizes of airborne particles may be a better option. Simpson et al.[8] utilized the same to test various modifications of barrier devices during simulated intubation. A barrier device with suction to create negative pressure led to a reduction in 0.3, 0.5, 1.0, and 2.5 micron particles but not in the 5.0 micron particles when compared to no device used. On the contrary, a barrier device with no negative pressure actually showed an increase in 1.0, 2.5 and 5.0 micron particle count compared to no device use. The results for 0.3 micron particle size were similar whether any barrier device was used or not. A review of 52 publications describing various barrier devices by Sorbello et al.[9] also concluded that barrier devices may only be effective in limiting large droplet spread and not the aerosolised virus particles. While the aerosol containment barrier device may serve as an adjunct during the COVID-19 pandemic, the importance of adequate personal protective equipment and hand hygiene practices cannot be over stated. They remain our first line of defense in protecting ourselves from the pathogen while providing effective care. Pre-procedure testing before laser/surgery is another way of creating a safe workplace. It is during these procedures that a prolonged exposure is expected. Over the past 6 months, we have been testing all premature infants for COVID-19 by polymerase chain reaction who are to undergo laser/surgery for ROP. From over 100 babies tested, only one has tested positive so far. Thus the overall rate of positivity in neonates appears to be low and this has been substantiated by other studies as well.[10] Adequate availability of personal protective equipment, extensive COVID-19 testing, and an added layer of protection by barrier devices should encourage more and more ROP specialists to continue providing their services safely to prevent an impending pandemic of preventable childhood blindness.

Commentary: Parental involvement in retinopathy of prematurity care: An individualized approach

Commentary: Parental involvement in retinopathy of prematurity care: An individualized approach

Epidemiology of Intravitreal Injections in Iran: Indications and Referral Patterns in a Tertiary Hospital.

PurposeTo study the relative contribution of major indications and geographic referral patterns for intravitreal bevacizumab injections in a tertiary hospital.MethodsIn this retrospective study, hospital electronic registry was used to categorize patients who had received intravitreal injections (IVIs) during the 2014–2016 period into different groups based on indications. Relative contribution of each indication and odds of being resident of provinces other than Tehran were determined.ResultsThe most prevalent indications for IVI were pathologies related to diabetes mellitus (DM) followed by choroidal neovascularization (CNV)/age-related macular degeneration (AMD) and retinal venous occlusion (RVO)-related complications. From 38,043 patients, 61.8% were residents of Tehran province. Patients in the CNV/AMD group were the oldest. Patients from Tehran province were significantly older (62.44 ±11.42 (12–99)) than patients who were referred from other provinces (59.23 ±11.39 (11–102)) (p=< 0.001). The majority of patients in all indication categories were from Tehran province, except for patients with retinopathy of prematurity (ROP). Odds of being referred from outside Tehran province for the ROP group compared to the DM-related, CNV/AMD, RVO-related and miscellaneous groups were 3.32, 4.27, 3.13 and 2.83, respectively (p<0.001).ConclusionDM-related ocular complications outnumber all other indications of IVIs combined. Considering the preventable nature of these complications, efficient health policies can significantly reduce the burden of IVIs in Iran. The contribution of each indication category in overall burden of IVIs seems to vary considerably between different countries which merits further studies. The disproportionately high ratio of ROP patients who are referred from other provinces to the capital province for treatment indicates a suboptimal distribution of ROP care services throughout the country.

Telemedicine for Retinopathy of Prematurity.

Background: Retinopathy of prematurity (ROP) is a disease of the retinal vasculature that remains a leading cause of childhood blindness worldwide despite improvements in the systemic care of premature newborns. Screening for ROP is effective and cost-effective, but in many areas, access to skilled examiners to conduct dilated examinations is poor. Remote screening with retinal photography is an alternative strategy that may allow for improved ROP care. Methods: The current literature was reviewed to find clinical trials and expert consensus documents on the state-of-the-art of telemedicine for ROP. Results: Several studies have confirmed the utility of telemedicine for ROP. In addition, several clinical studies have reported favorable long-term results. Many investigators have reinforced the need for detailed protocols on image acquisition and image interpretation. Conclusions: Telemedicine for ROP appears to be a viable alternative to live ophthalmoscopic examinations in many circumstances. Standardization and documentation afforded by telemedicine may provide additional benefits to providers and their patients. With continued improvements in image quality and affordability of imaging systems as well as improved automated image interpretation tools anticipated in the near future, telemedicine for ROP is expected to play an expanding role for a uniquely vulnerable patient population.

Retinopathy of prematurity care in peripheral districts in Odisha, India: Pilot for a sustainable model.

The outcome of a retinopathy of prematurity (ROP) program initiated in five districts of Odisha over 3 years with partnerships between the government and non-government organizations was prospectively analyzed. The mentoring partners trained the district ophthalmologists and neonatal care providers; the program was handed over when the trainees were considered competent enough to diagnose and treat babies with ROP. During the project period (July 2016–June 2019), 3058 babies were examined; ROP was detected in 33.81% (n = 1034) and 5.06% (n = 159) babies required treatment. At the end of the project, ROP screening was possible in all five districts, and treatment was possible in three districts. ROP care nodal centers were built in one government medical college. To strengthen the initial gain, we recommend creating an Odisha Retinopathy of Prematurity (OD-ROP) steering committee with private–public partnerships to support the program and monitor its progress in other districts of Odisha.

Deep Learning Algorithm for Automated Diagnosis of Retinopathy of Prematurity Plus Disease.

PurposeThis study describes the initial development of a deep learning algorithm, ROP.AI, to automatically diagnose retinopathy of prematurity (ROP) plus disease in fundal images.MethodsROP.AI was trained using 6974 fundal images from Australasian image databases. Each image was given a diagnosis as part of real-world routine ROP screening and classified as normal or plus disease. The algorithm was trained using 80% of the images and validated against the remaining 20% within a hold-out test set. Performance in diagnosing plus disease was evaluated against an external set of 90 images. Performance in detecting pre-plus disease was also tested. As a screening tool, the algorithm's operating point was optimized for sensitivity and negative predictive value, and its performance reevaluated.ResultsFor plus disease diagnosis within the 20% hold-out test set, the algorithm achieved a 96.6% sensitivity, 98.0% specificity, and 97.3% ± 0.7% accuracy. Area under the receiver operating characteristic curve was 0.993. Within the independent test set, the algorithm achieved a 93.9% sensitivity, 80.7% specificity, and 95.8% negative predictive value. For detection of pre-plus and plus disease, the algorithm achieved 81.4% sensitivity, 80.7% specificity, and 80.7% negative predictive value. Following the identification of an optimized operating point, the algorithm diagnosed plus disease with a 97.0% sensitivity and 97.8% negative predictive value.ConclusionsROP.AI is a deep learning algorithm able to automatically diagnose ROP plus disease with high sensitivity and negative predictive value.Translational RelevanceIn the context of increasing global disease burden, future development may improve access to ROP diagnosis and care.