Retinopathy Of Prematurity Screening Program 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.

Comparative analysis of risk factors for retinopathy of prematurity in single and multiple birth neonates

AimTo conduct a comparative analysis of risk factors for retinopathy of prematurity (ROP) in single- and multiple-born neonates.MethodsIn a retrospective evaluation of 521 premature neonates, encompassing singletons, twins, and triplets born at or before 34 weeks of gestational age with a birthweight of less than 2000 g and who completed the ROP screening program, between 2020 and 2023, in outpatient referral ROP screening clinic affiliated by Shiraz University of Medical Sciences, were included. Neonates with the eligibility criteria were enrolled in the screening program from 28 days old age and followed up to discharge or treatment based on national ROP screening guideline. Data on ROP severity, outcome, treatment modality, and risk factors, including gestational age (GA), birth weight (BW), sex, duration of neonatal intensive care unit (NICU) admission, oxygen supplementation, mechanical ventilation, blood transfusion, method of delivery, and maternal and neonatal comorbidities, were extracted and compared between premature neonates from singleton and multiple births.Results The analysis of the ROP severity distribution revealed 238 neonates (45.7%) with low-risk (type 2 prethreshold ROP or less severe) ROP and 16 (3.1%) with high-risk (type I prethreshold ROP or more severe) ROP who underwent treatment. According to the comparative analysis of risk factors in neonates with ROP requiring treatment, multiple birth neonates exhibited significantly greater GA (27.50 ± 3.27 vs. 30.00 ± 2.00 vs. 31.14 ± 0.38 weeks, p = 0.032 for singletons, twins and triplets, respectively); greater BW (861.67 ± 274.62 vs. 1233.33 ± 347.75 vs. 1537.14 ± 208.86 g, p = 0.002); and shorter duration of NICU admission (60.17 ± 21.36 vs. 34.00 ± 12.17 vs. 12.00 ± 6.32 days, p = 0.001) and oxygen supplementation (47.33 ± 16.57 vs. 36.00 ± 8.49 vs. 4.60 ± 2.41 days, p = 0.001). There was no significant difference between single-born neonates and multiple-born neonates regarding the prevalence of other risk factors. Multiple-born neonates with no ROP and low risk ROP showed significantly lower GA and BW compared to singletons (p < 0.001).ConclusionMultiple gestation neonates may develop high-risk ROP requiring treatment at a greater gestational age and birth weight and at a lower duration of oxygen supplementation and NICU admission compared to the single birth neonates. This pattern prompts a reevaluation of screening criteria, suggesting a potential need to consider multiple birth neonates with lower traditional risk factors in screening programs. This pattern should be further evaluated in larger populations of multiple born premature neonates.

Vision on wheels: Technician-assisted retinopathy of prematurity screening in rural Tamil Nadu and Andhra Pradesh: 2018-2021 Project Report.

To analyze the incidence of sight-threatening retinopathy of prematurity (ROP) in premature infants in rural Tamil Nadu and Andhra Pradesh from 2018 to 2021, and to analyze its association with birthweight (BW), gestational age (GA), and postconceptional age (PCA). Project Vision on Wheels is a free ROP screening and treatment program initiated by a tertiary eye care center in South India in June 2018 to screen preterm infants in rural areas in 11 centers in Tamil Nadu and Andhra Pradesh by trained technicians. Infants with sight-threatening ROP were immediately shifted for vision-preserving laser. Of the 18,117 infants screened from 2018 to 2021, 1046 infants underwent laser, with the majority being bigger and more mature when compared to Western data. There was a yearly increase in the number of infants with sight-threatening ROP in the lower BW, GA, and PCA categories. The timely detection of the condition by committed screening led to salvage of vision by timely laser in 100% of the treated babies in all the years. The incidence of sight-threatening ROP had a yearly decrease in higher BW, GA, and PCA categories. These trends were statistically significant ( P = 0.001 for ROP and BW, P = 0.037 for ROP and GA, and P = 0.001 for ROP and PCA). The statistically significant trend of decreasing sight-threatening ROP in babies with higher BW, GA, and PCA and increasing treatable ROP in younger and smaller babies (with lower BWs, GAs, and PCAs) in rural India, over time, is a hitherto unreported finding. This is the first such study in rural Tamil Nadu and Andhra Pradesh combined, with the largest data to date (as per MEDLINE search) to document this healthier trend.

Evaluation of an Artificial Intelligence System for Retinopathy of Prematurity Screening in Nepal and Mongolia.

To evaluate the performance of a deep learning (DL) algorithm for retinopathy of prematurity (ROP) screening in Nepal and Mongolia. Retrospective analysis of prospectively collected clinical data. Clinical information and fundus images were obtained from infants in 2 ROP screening programs in Nepal and Mongolia. Fundus images were obtained using the Forus 3nethra neo (Forus Health) in Nepal and the RetCam Portable (Natus Medical, Inc.) in Mongolia. The overall severity of ROP was determined from the medical record using the International Classification of ROP (ICROP). The presence of plus disease was determined independently in each image using a reference standard diagnosis. The Imaging and Informatics for ROP (i-ROP) DL algorithm was trained on images from the RetCam to classify plus disease and to assign a vascular severity score (VSS) from 1 through9. Area under the receiver operating characteristic curve and area under the precision-recall curve for the presence of plus disease or type 1 ROP and association between VSS and ICROP disease category. The prevalence of type 1 ROP was found to be higher in Mongolia (14.0%) than in Nepal (2.2%; P<0.001) in these data sets. In Mongolia (RetCam images), the area under the receiver operating characteristic curve for examination-level plus disease detection was 0.968, and the area under the precision-recall curve was 0.823. In Nepal (Forus images), these values were 0.999 and 0.993, respectively. The ROP VSS was associated with ICROP classification in both datasets (P < 0.001). At the population level, the median VSS was found to be higher in Mongolia (2.7; interquartile range [IQR], 1.3-5.4]) as compared with Nepal (1.9; IQR, 1.2-3.4; P < 0.001). These data provide preliminary evidence of the effectiveness of the i-ROP DL algorithm for ROP screening in neonatal populations in Nepal and Mongolia using multiple camera systems and are useful for consideration in future clinical implementation of artificial intelligence-based ROP screening in low- and middle-income countries.

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.

Diagnostic Accuracy of Wide-Field Digital Retinal Images in Retinopathy of Prematurity Detection: Systematic Review and Meta-Analysis

Purpose To evaluate the diagnostic accuracy of the wide-field digital retinal imaging (WFDRI) for the detection of Retinopathy of Prematurity (ROP) in premature infants as compared to the binocular indirect ophthalmoscopy (BIO). Methods This systematic review and meta-analysis included the publications searched through PubMed (Medline), EMBASE, Scopus, Web of Science, Cochrane Library databases and Clinical Trials. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2, the hierarchical summary receiver operating characteristic, meta-regression, publication bias analyses, and the GRADE methodology for the certainty of the overall evidence were conducted. The pooled effect sizes of the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were calculated. Results Total sixteen eligible studies from 10 articles were included with total 2,537 image interpretations from 697 premature infants. Less than 50% risk of bias and low concern were found in each domain across all articles by QUADAS-2. The pooled effect sizes showed the sensitivity of 0.77 (95% confidence interval (C.I.): 0.69–0.84), specificity of 0.96 (95% C.I.: 0.92–0.98), PLR of 20.9 (95% C.I.: 10.2–42.5), NLR of 0.23 (95% C.I.: 0.17–0.33) and DOR of 89 (95% C.I.: 43–185) as compared to BIO. The income level, setting, mean/median birth weight and gestational age contributed to the significant differences in sensitivity (p < 0.001). No publication bias was found among these 16 studies. The GRADE quality of evidence showed moderate for the pooled sensitivity and high for the pooled specificity. Conclusions The diagnostic accuracy based on WFDRI is substantial and comparable to BIO, supporting its application in the ROP screening programs.

Retinopathy of prematurity screening: A narrative review of current programs, teleophthalmology, and diagnostic support systems.

PURPOSE:Neonatal care in middle-income countries has improved over the last decade, leading to a “third epidemic” of retinopathy of prematurity (ROP). Without concomitant improvements in ROP screening infrastructure, reduction of ROP-associated visual loss remains a challenge worldwide. The emergence of teleophthalmology screening programs and artificial intelligence (AI) technologies represents promising methods to address this growing unmet demand in ROP screening. An improved understanding of current ROP screening programs may inform the adoption of these novel technologies in ROP care.METHODS:A critical narrative review of the literature was carried out. Publications that were representative of established or emerging ROP screening programs in high-, middle-, and low-income countries were selected for review. Screening programs were reviewed for inclusion criteria, screening frequency and duration, modality, and published sensitivity and specificity.RESULTS:Screening inclusion criteria, including age and birth weight cutoffs, showed significant heterogeneity globally. Countries of similar income tend to have similar criteria. Three primary screening modalities including binocular indirect ophthalmoscopy (BIO), wide-field digital retinal imaging (WFDRI), and teleophthalmology were identified and reviewed. BIO has documented limitations in reduced interoperator agreement, scalability, and geographical access barriers, which are mitigated in part by WFDRI. Teleophthalmology screening may address limitations in ROP screening workforce distribution and training. Opportunities for AI technologies were identified in the context of these limitations, including interoperator reliability and possibilities for point-of-care diagnosis.CONCLUSION:Limitations in the current ROP screening include scalability, geographical access, and high screening burden with low treatment yield. These may be addressable through increased adoption of teleophthalmology and AI technologies. As the global incidence of ROP continues to increase, implementation of these novel modalities requires greater consideration.

RETINOPATHY OF PREMATURITY, AN IMPORTANT PUBLIC HEALTH PROBLEM IN PAKISTAN: A REVIEW

Introduction: Retinopathy of Prematurity (ROP) is the significant cause of blindness in children globally. Although the incidence of ROP is greater in premature infants worldwide, statistics show that it is more common in low-middle-income countries. Multiple causes and complications of ROP in low middle-income countries have been reported therefore the purpose of this literature review was to review the findings from literature about the burden, causes, outcomes, and important preventive measures of ROP for low middle-income countries, especially in Pakistan. Methods: A comprehensive review of the literature was conducted from published articles. Research studies were selected that included risk factors of ROP, screening, and diagnosis of ROP, treatment of ROP, and prevention of ROP.Results The cause of the high rate of ROP in Low-middle income countries (LMICs) includes a high rate of preterm babies, lack of awareness regarding ROP, financial instability, and insufficient treatment and screening programs at the newborn units. ROP is found to be the significant cause of preventable blindness in South Asia. There are three different levels of prevention aimed at reducing the burden of ROP in LMICs. Primary prevention aims at reduction in preterm births, secondary prevention aims at early diagnosis of the disease and tertiary prevention aims at reducing deterioration of conditions due to disease. Conclusion: The emphasis on preventive measures especially primary and secondary level prevention can help in decreasing the burden of ROP. This requires a multidisciplinary approach at all levels including at the level of policymaking, program implementation, health care providers, and community level.

Addressing the Third Epidemic of Retinopathy of Prematurity Through Telemedicine and Technology: A Systematic Review.

The rising prevalence of retinopathy of prematurity (ROP) in low- and middle-income countries has increased the need for screening at-risk infants. The purpose of this article was to review the impact of tele-medicine and technology on ROP screening programs. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed using PubMed, Pro-Quest, and Google Scholar bibliographic search engine. Terms searched included retinopathy of prematurity, telemedicine, and tele-ophthalmology. Data regarding internet access and gross domestic product per capita were obtained from the World Bank. Information was also obtained about internet access, speeds, and costs in low-income countries. There has been increasing integration of telemedicine and technology for ROP screening and management. Low-income countries are using available internet options and information and communications technology for ROP screening, which can aid in addressing the unique challenges faced by low-income countries. This provides a promising solution to the third epidemic of ROP by expanding and improving screening and management. Although telemedicine systems may serve as a cost-effective approach to facilitate delivery of health care, programs (especially in lowand middle-income countries) require national support to maintain its infrastructure. [J Pediatr Ophthalmol Strabismus. 2021;58(4):261-269.].

Applications of Artificial Intelligence for Retinopathy of Prematurity Screening.

Childhood blindness from retinopathy of prematurity (ROP) is increasing as a result of improvements in neonatal care worldwide. We evaluate the effectiveness of artificial intelligence (AI)-based screening in an Indian ROP telemedicine program and whether differences in ROP severity between neonatal care units (NCUs) identified by using AI are related to differences in oxygen-titrating capability. External validation study of an existing AI-based quantitative severity scale for ROP on a data set of images from the Retinopathy of Prematurity Eradication Save Our Sight ROP telemedicine program in India. All images were assigned an ROP severity score (1-9) by using the Imaging and Informatics in Retinopathy of Prematurity Deep Learning system. We calculated the area under the receiver operating characteristic curve and sensitivity and specificity for treatment-requiring retinopathy of prematurity. Using multivariable linear regression, we evaluated the mean and median ROP severity in each NCU as a function of mean birth weight, gestational age, and the presence of oxygen blenders and pulse oxygenation monitors. The area under the receiver operating characteristic curve for detection of treatment-requiring retinopathy of prematurity was 0.98, with 100% sensitivity and 78% specificity. We found higher median (interquartile range) ROP severity in NCUs without oxygen blenders and pulse oxygenation monitors, most apparent in bigger infants (>1500 g and 31 weeks' gestation: 2.7 [2.5-3.0] vs 3.1 [2.4-3.8]; P = .007, with adjustment for birth weight and gestational age). Integration of AI into ROP screening programs may lead to improved access to care for secondary prevention of ROP and may facilitate assessment of disease epidemiology and NCU resources.

Retinopathy of prematurity: Current status, treatment, prevention, and future directions from the perspective of developing countries

Retinopathy of prematurity (ROP) is the leading cause of preventable blindness in pediatric population living in developing countries. Increasing survival rates of premature patients have been globally improving during the last years and this is the main reason of blindness rate escalation secondary to ROP. The advent of intravitreal injections of antiangiogenic agents in therapeutic ophthalmological arsenal has provided an easier and faster way to prevent retinal detachment in this extremely fragile population. In the nearest future, we will witness, how medical science will provide enough scientific evidence to treat properly these patients with the lowest and safest dose of anti-vascular endothelial growth factor intraocular injections with the fewer systemic side effects. Meanwhile, transpupillary retinal laser photocoagulation of the avascular retina will remain the “gold standard” for ROP treatment, and for sure, this option could also provide a feasible alternative in the future for those cases, where intravitreal injections will fail. Neonatologists and ophthalmologists should keep on working together to fight against children's blindness, synchronizing retinal examinations timing criteria by adequate eye screening. Low- and middle-income countries' health governmental care suppliers should organize suitable programs for providing adequate neonatal care for premature patients and preventing, detecting, and treating effectively ROP. Training and teaching ROP screening and treatment programs are also a responsibility to be taken by local health care authorities and university residency courses for young ophthalmologists. This review describes the situation, state-of-the-art treatment, blindness prevention options from developing countries' viewpoints.

Retinopathy of prematurity in a tertiary facility: an initial report of a screening programme

Background: Retinopathy of prematurity (ROP) screening in Nigeria is at a nascent stage and at the moment there are no National guidelines for ROP screening in Nigeria. Thus it is desirable for screening programs to report findings amongst screened preterm infants in order to facilitate the development of national ROP screening criteria and guidelines. The aim of this report is to describe the frequency, severity and risk factors for retinopathy of prematurity (ROP) among preterm and very low-birth-weight babies screened within the first year of initiating an ROP screening program at a Nigerian tertiary facility.&#x0D; Methods: A cross-sectional study of infants born at less than 34 weeks gestational age; or with birth weight less than 1500g between May 2016 and May 2017. ROP screening examinations were performed by ophthalmologists with the use of an indirect ophthalmoscope, after pupillary dilation, in collaboration with the neonatology team. Information on gestational age at birth, birth weight, oxygen therapy and presence of other risk factors were recorded and analyzed.&#x0D; Results: A total of 74 infants were screened during the period. There were 36 (48.6%) males. Mean gestational age at birth was 29.6 (±2.35) weeks. Mean birth weight was 1.26 (±0.27) kg with a range of 800 to 1950g. ROP was detected in 9 (12.2%) infants. Two (22.2%) of these had Threshold ROP. There was no significant difference between the mean birth weight and mean gestational age of the infants who had ROP compared to those without ROP. The two infants with Threshold ROP were treated with intravitreal Bevazicumab and had regression of ROP.&#x0D; Conclusion: Retinopathy of prematurity was diagnosed in at risk infants in this facility. There is, therefore, a need to establish ROP screening programs in all neonatal units across the country. In addition, established programs need to evaluate their screening criteria with a view towards developing country-specific screening guidelines.&#x0D; Keywords: Retinopathy; Prematurity; Preterm; Neonates; Nigeria; Africa

Evaluation of artificial intelligence-based telemedicine screening for retinopathy of prematurity

Retrospective evaluation of a deep learning-derived retinopathy of prematurity (ROP) vascular severity score in an operational ROP screening program demonstrated high diagnostic performance for detection of type 2 or worse ROP. To our knowledge, this is the first report in the literature that evaluated the use of artificial intelligence for ROP screening and represents a proof of concept. With further prospective validation, this technology might improve the accuracy, efficiency, and objectivity of diagnosis and facilitate earlier detection of disease progression in patients with potentially blinding ROP.

Regionally Specific Economic Impact of Screening and Treating Retinopathy of Prematurity in Middle-Income Societies in the Philippines

To estimate the economic effects of implementing a universal screening and treatment program for retinopathy of prematurity (ROP) in the Philippines with the Economic Model for Retinopathy of Prematurity (EcROP). The EcROP is a cost-effectiveness, cost-benefit, and cost-utility analysis. Fifty parents of legally blind individuals (aged 3 to 28 years) from three schools for the blind in the Philippines were interviewed to estimate the societal burden of raising a blind child. A decision tree analytic model, with deterministic and probabilistic sensitivity analysis, was used to calculate the incremental cost-effectiveness ratio (primary outcome) and the incremental monetary benefit (secondary outcome) for implementing an optimal national ROP program, compared to estimates of the current policy. Findings were extrapolated to estimate the national economic benefit of an ideal screening and treatment program. The incremental cost-effectiveness ratio for a national program over the current policy was strongly favorable to the ideal program for the Philippines and represents an opportunity for substantial societal cost savings. The per-child incremental, annual monetary benefit of a national program over the current policy was $2,627. Extrapolating to the population of children at risk in 1 year showed that the national annual net benefit estimate would be $64,320,692, which is favorable to the current policy. The EcROP demonstrates that implementing a national ROP screening and treatment program is cost-saving and cost-effective, and would substantially decrease childhood blindness in the Philippines. [J Pediatr Ophthalmol Strabismus. 2019;56(6):388-396.].

Telemedicine for Retinopathy of Prematurity in 2020.

Purpose: Retinopathy of prematurity (ROP) is the leading cause of visual impairment in premature infants, and middle-income nations are currently experiencing the “third epidemic” of ROP. Screening programs are essential to prevent negative visual outcomes, but screening efforts require a great amount of resources from healthcare systems and are difficult to marshal, particularly in geographically isolated or resource-limited settings. Telemedical screening programs using remote digital fundus imaging (RDFI) systems hold the promise of alleviating many of the burdens that currently make screening for ROP logistically challenging. Methods: Literature review of the current evidence for RDFI telescreening for ROP, with editorial discussion and recommendations. Results: In this review, we summarize the robust body of literature regarding the efficacy of RDFI, the feasibility of telescreening programs, and experiences from current live telescreening programs. We discuss the strengths and limitations of the current evidence and of the screening programs and consider the best practices in developing de novo telemedical screening programs for ROP. The review concludes with a discussion of promising future areas of research and development. Conclusions: RDFI ROP screening programs can be accurate and reliable. They show promise in improving many current challenges in screening infants for ROP, may be able to improve some aspects of care, and have been demonstrated to be cost-effective.

Evaluation of refractive errors in retinopathy of prematurity screening.

Aim To evaluate the frequency of refractive errors in premature children in retinopathy of prematurity (ROP) screening to find mutual connection of the prematurity level, disease activity and refractive errors. Methods A retrospective study was conducted in the Eye Clinic of the University Clinical Centre Sarajevo, between December 2013 and January 2017. A total of 126 patients of gestational age ≤ 34 weeks and birth weight ≤ 2000 g underwent ROP screening program. The patients were divided into three groups: patients without ROP (n=15), patients with spontaneous regression (n=106) and those with active form of ROP (n=5). Results There were 68 (54.0%) patients with refractive errors: 45 (35.7%) had hyperopia, 17 (13.5%) myopia and six (4.8%) astigmatism. There were three (60.0%) patients with an active form of ROP who had refractive errors: two (40.0%) had myopia and one (20.0%) hyperopia. The group without active ROP had hyperopia as most frequent refractive error, with 10 (66.7%) patients. The average birth weight of the patients without refractive errors was 1403.9±43.4 g compared to 1390.3±104.2 g of the patients with refractive errors (p=0.498). The average gestational age was 29.7±0.3 weeks in patients without and 29.0 ± 0.3 weeks in patients with refractive errors (p=0.126). Conclusion The birth weight and the gestational age were significantly lower in patients with the active form of ROP. Lower gestational age and birth weight of premature children increase the chance for the development of refractive errors such as hyperopia in all premature children and myopia in patients with active form of ROP.

The Association Between Retinopathy of Prematurity and Ocular Growth.

The purpose of this study was to prospectively investigate the association between retinopathy of prematurity (ROP) and ocular growth in premature infants during the earliest weeks of life. Premature infants in the national ROP screening program were recruited and examined at 1- or 2-week intervals between 30 and 38 weeks of postmenstrual age. One hundred infants with gestational age (GA) between 24 and 35 weeks (30.04 + 2.13), and birth weight (BW) between 550 and 2060 g (1251.45 + 317.19) were included in the study. At each examination, the presence, stage, and zone of ROP were recorded along with axial length (AL), central corneal thickness (CCT), and weight gain. Biometric parameters were measured by A-scan biometry. Study variables included GA, BW, AL, CCT, weight gain, relative weight (RW), and dif_AL, dif_CCT, and dif_weight, which are the differences between two consecutive recordings of the same infant. Multiple regression analysis models were used to determine the association between the study variables and ROP. dif_AL, dif_CCT, and RW were the most appropriate variables to detect the optimal threshold points that discriminate ROP: weekly increase of AL < 0.095 mm, weekly reduction of CCT < 0.5 μm, or weekly weight gain < 7% is associated with ROP development. ROP is associated with delayed ocular development, as eyes of premature infants with ROP have shorter axial lengths and thicker corneas than eyes of premature infants without ROP. The association of AL, CCT, and weight gain with ROP could be of value for future development of predictive models for ROP.

Ocular outcomes and comorbidities in preterm infants enrolled for retinopathy of prematurity screening: A cohort study from western India

BACKGROUND:Retinopathy of prematurity (ROP) is emerging as an important cause of childhood blindness in middle-income countries such as India. Although blindness can be prevented in most cases with timely screening and treatment, certain ocular comorbidities can lead to visual impairment. We evaluated and compared 1-year visual, refractive, and structural outcomes and comorbidities in three subsets of preterm infants enrolled for screening of ROP.SUBJECTS AND METHODS:Preterm children enrolled in the hospital's ROP screening program and with diagnosis of no ROP, mild ROP, or severe ROP were followed at 1 year of age to evaluate and compare visual, refractive, and structural outcomes as well as the presence of ocular comorbidities. Risk of poor outcome was calculated in children with mild and severe ROP reference population being children without ROP.RESULTS:Eyes with severe ROP were at highest risk of poor visual (risk ratio [RR]: 3.5, P < 0.001), refractive (RR: 45, P < 0.001), and structural (RR: 11, P = 0.006) outcome as well as ocular comorbidities (RR 11, P < 0.001). Eyes with mild ROP were at higher risk of myopia (RR: 11, P = 0.06) and ocular comorbidities (RR: 4, P = 0.04). Sixteen (16%) of the eyes without ROP developed poor visual outcome.CONCLUSION:Eyes with severe ROP are at highest risk of poor ocular outcomes and comorbidities and need a long-term follow-up. Eyes which do not develop ROP can have poor visual outcome and need to be assessed within the 1st year of life.

Screening for retinopathy of prematurity: Trends over the past 5 years in two German university hospitals

The number of preterm births in Germany has been increasing continuously over the past decades. Retinopathy of prematurity (ROP) is amajor complication of preterm birth and one of the leading causes of blindness in children. This study analyzes the development of the incidence of ROP over the past 5 years at two German university hospitals, utilizing data from ROP screening examinations. We assessed all children born in the years 2012-2016 who were included in the ROP screening program at two German university hospitals according to the criteria of the German ROP screening guidelines. Parameters such as gestational age, birth weight, ROP stage and zone, and need for therapeutic intervention were assessed. We analyzed the data of 863 children who had undergone atotal of 4117 screening examinations. The number of children included in the screening program per study year increased continuously over the study period by atotal of 43.1% (137 in 2012, 196 in 2016). Likewise, the number of screening examinations per year increased by 58.4% (608 in 2012, 963 in 2016). Overall, 27.5% of screened infants were diagnosed with ROP of any stage and 2.5% required treatment for ROP. The number of children diagnosed with ROP of any stage per year increased by 100.0% (32 in 2012, 64 in 2016). Mean gestational age (29.0 ± 3.0weeks) and mean birth weight (1192 ± 513 g) remained stable over the study period. Screening data for ROP from two German university hospitals demonstrates asignificant increase in both the number of screened infants and the number of infants affected by ROP over the past 5 years.

Cost analysis of remote telemedicine screening for retinopathy of prematurity

ObjectiveTo compare costs of 2 screening modalities for retinopathy of prematurity (ROP): telemedicine imaging with remote interpretation versus in-person binocular indirect ophthalmoscopy (BIO). DesignRetrospective chart review. ParticipantsInfants from an existing telemedicine screening program at 2 cities in Ontario, Canada. MethodsWe conducted a cost analysis comparison from the perspective of the Ministry of Health. Patient level data was used for the telemedicine group. A hypothetical control group consisted of the minimum number of BIO and interhospital transfers if the existing patients were screened in person. Costs included in-person examinations, transfers, setting up, and ongoing costs of telemedicine screening. Costs were compared using the Mann–Whitney U test and are reported in 2014 Canadian dollars. ResultsA total of 102 and 72 infants were screened from Sudbury and Barrie, respectively; 3% and 2% of infants in the telemedicine group were transferred for BIO from Sudbury and Barrie, respectively. All infants in the control group would have required at least one transfer for BIO. The average total cost per eye examination was $4855 ± $5616 and $4540 ± $3129 for the telemedicine group and $19 834 ± $13 814 and $2429 ± $1664 for the control group from Sudbury and Barrie, respectively (p < 0.001). Interhospital transfer cost for the control group was $19 489 ± $13 605 and $2055 ± $1471 compared to $635 ± $3968 and $30 ± $197 for the telemedicine group (p < 0.001) in Sudbury and Barrie, respectively. ConclusionsTelemedicine appears to be an economically attractive option depending on the location and number of infants screened. This information is useful for planning similar ROP screening programs.