Worse Retinopathy Of Prematurity Research Articles

Isolated Retinal Neovascularization in Retinopathy of Prematurity: Clinical Associations and Prognostic Implications

Isolated retinal neovascularization (IRNV) is a common finding in patients with stage 2 and 3 retinopathy of prematurity (ROP). This study aimed to further classify the clinical course and significance of these lesions (previously described as "popcorn" based on clinical appearance) in patients with ROP as visualized with ultrawidefield OCT (UWF-OCT). Single center, retrospective case series. Images were collected from 136 babies in the Oregon Health and Science University neonatal intensive care unit. A prototype UWF-OCT device captured en face scans (>140°), which were reviewed for the presence of IRNV along with standard zone, stage, and plus classification. In a cross-sectional analysis we compared demographics and the clinical course of eyes with and without IRNV. Longitudinally, we compared ROP severity using a clinician-assigned vascular severity score (VSS) and compared the risk of progression among eyes with and without IRNV using multivariable logistic regression. Differences in clinical demographics and disease progression between patients with and without IRNV. Of the 136 patients, 60 developed stage 2 or worse ROP during their disease course, 22 of whom had IRNV visualized on UWF-OCT (37%). On average, patients with IRNV had lower birth weights (BWs) (660.1 vs. 916.8 g, P= 0.001), gestational age (GA) (24.9 vs. 26.1 weeks, P= 0.01), and were more likely to present with ROP in zone I (63.4% vs. 15.8%, P < 0.001). They were also more likely to progress to stage 3 (68.2% vs. 13.2%, P < 0.001) and receive treatment (54.5% vs. 15.8%, P= 0.002). Eyes with IRNV had a higher peak VSS (5.61 vs. 3.73, P < 0.001) and averaged a higher VSS throughout their disease course. On multivariable logistic regression, IRNV was independently associated with progression to stage 3 (P= 0.02) and requiring treatment (P= 0.03), controlling for GA, BW, and initial zone 1 disease. In this single center study, we found that IRNV occurs in higher risk babies and was an independent risk factor for ROP progression and treatment. These findings may have implications for OCT-based ROP classifications in the future. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Epidemiologic Evaluation of Retinopathy of Prematurity Severity in a Large Telemedicine Program in India Using Artificial Intelligence

Epidemiological changes in retinopathy of prematurity (ROP) depend on neonatal care, neonatal mortality, and the ability to carefully titrate and monitor oxygen. We evaluate whether an artificial intelligence (AI) algorithm for assessing ROP severity in babies can be used to evaluate changes in disease epidemiology in babies from South India over a 5-year period. Retrospective cohort study. Babies (3093) screened for ROP at neonatal care units (NCUs) across the Aravind Eye Care System (AECS) in South India. Images and clinical data were collected as part of routine tele-ROP screening at the AECS in India over 2 time periods: August 2015 to October 2017 and March 2019 to December 2020. All babies in the original cohort were matched 1:3 by birthweight (BW) and gestational age (GA) with babies in the later cohort. We compared the proportion of eyes with moderate (type 2) or treatment-requiring (TR) ROP, and an AI-derived ROP vascular severity score (from retinal fundus images) at the initial tele-retinal screening exam for all babies in a district, VSS), in the 2 time periods. Differences in the proportions of type 2 or worse and TR-ROP cases, and VSS between time periods. Among BW and GA matched babies, the proportion [95% confidence interval {CI}] of babies with type 2 or worse and TR-ROP decreased from 60.9% [53.8%-67.7%] to 17.1% [14.0%-20.5%] (P < 0.001) and 16.8% [11.9%-22.7%] to 5.1% [3.4%-7.3%] (P < 0.001), over the 2 time periods. Similarly, the median [interquartile range] VSS in the population decreased from 2.9 [1.2] to 2.4 [1.8] (P < 0.001). In South India, over a 5-year period, the proportion of babies developing moderate to severe ROP has dropped significantly for babies at similar demographic risk, strongly suggesting improvements in primary prevention of ROP. These results suggest that AI-based assessment of ROP severity may be a useful epidemiologic tool to evaluate temporal changes in ROP epidemiology. Proprietary or commercial disclosure may be found after the references.

Quantitative analysis of tear angiogenic factors in retinopathy of prematurity: a pilot biomarker study

To determine whether vascular endothelial growth factor (VEGF), angiopoeitin-1 (Ang-1), angiopoetin-2 (Ang-2), and matrix metalloproteinase-9 (MMP-9) can be reliably collected and analyzed from infant tears to aid in the diagnosis of retinopathy of prematurity (ROP) and enhance the ability to objectively monitor its clinical course. In this nonrandomized controlled investigation, tear and saliva samples collected from 20 premature infants during serial ophthalmic examination were analyzed using enzyme-linked immunoassay with results analyzed as a function of disease stage and need for treatment. Tear volume was directly correlated with corrected gestational age (P < 0.001). Tear VEGF levels from samples corresponding to stage 3 ROP were 47.9% lower (P = 0.006) than in samples corresponding to stage 0-1 and 49.1% lower (P = 0.01) than in samples corresponding to stage 2 ROP. There were no between-group differences after normalizing tear VEGF by saliva VEGF levels. Tear/saliva ratio for Ang-1 was 200% greater (P = 0.042) and tear/saliva ratio for Ang-2 was 165% greater (P = 0.035) in samples corresponding to stage 2 versus stage 0-1 ROP disease. Ang-1/Ang-2 ratio was lower in samples from infants who developed stage 2 or worse ROP than in samples from infants who never developed worse than stage 1 ROP (P = 0.031). In this study cohort, cytokines involved in the pathophysiology of ROP could be reliably identified in and analyzed from infant tears, and showed variation with ROP severity.

Prenatal intrauterine growth restriction and risk of retinopathy of prematurity

Low birthweight and decreased postnatal weight gain are known predictors of worse retinopathy of prematurity (ROP) but the role of prenatal growth patterns in ROP remains inconclusive. To distinguish small for gestational age (SGA) from intrauterine growth restriction (IUGR) as independent predictors of ROP, we performed a retrospective cohort study of patients who received ROP screening examinations at a level IV neonatal intensive care unit over a 7-year period. Data on IUGR and SGA status, worst stage of and need for treatment for ROP, and postnatal growth was obtained. 343 infants were included for analysis (mean gestational age = 28.6 weeks and birth weight = 1138.2 g). IUGR infants were more likely to have a worse stage of ROP and treatment-requiring ROP (both p < 0.0001) compared to non-IUGR infants. IUGR infants were more likely to be older at worst stage of ROP (p < 0.0001) and to develop postnatal growth failure (p = 0.01) than non-IUGR infants. Independent of postnatal growth failure status, IUGR infants had a 4–5 × increased risk of needing ROP treatment (p < 0.001) compared to non-IUGR infants. SGA versus appropriate for gestational age infants did not demonstrate differences in retinopathy outcomes, age at worst ROP stage, or postnatal growth failure. These findings emphasize the importance of prenatal growth on ROP development.

Evaluation of real-time video from the digital indirect ophthalmoscope for telemedicine consultations in retinopathy of prematurity

Introduction This study aimed to evaluate the validity of using real-time video indirect ophthalmoscopy for telemedicine consultations for paediatric retinal findings, using retinopathy of prematurity (ROP) as a model disease. Methods An ophthalmologist simultaneously performed and recorded routine ROP screenings on enrolled premature infants (aged ≤30 weeks and weighing <1500 g) using the Keeler digital indirect ophthalmoscope. Examinations were graded as no ROP, mild, type 1 or type 2. Masked to clinical findings, another ophthalmologist reviewed and graded streamed video feed transmitted at 4096 kbps. We compared the sensitivity and specificity of diagnosing ROP via streamed and stored-and-forwarded video clips to the gold-standard in-person examination. Results A total of 150 examinations of individual eyes from 34 babies were included. The median postmenstrual age (PMA) at delivery was 24 weeks (range 23–34 weeks), the median birth weight was 630 g (range 455–1530 g) and the median PMA at examination was 37 weeks (range 31–54 weeks). Of those infants with any ROP, the sensitivity and specificity of streamed examinations were 100% and 70.6%, respectively. For type 2 or worse ROP, the sensitivity and specificity were 92.5% and 86.1%, respectively. For type 1 ROP, the sensitivity and specificity were 100% and 99.3%, respectively. Sensitivities (unless already 100%) and specificities were slightly higher for store-and-forward evaluations. Discussion Streamed video feed from the digital indirect ophthalmoscope can be utilised to diagnose clinically significant ROP accurately, though store-and-forward video review yielded slightly better results.

Development of Screening Criteria for Retinopathy of Prematurity in Ulaanbaatar, Mongolia, Using a Web-based Data Management System.

To describe a process for identifying birth weight (BW) and gestational age (GA) screening guidelines in Mongolia. This was a prospective cohort study in a tertiary care hospital in Ulaanbataar, Mongolia, of 193 premature infants with GA of 36 weeks or younger and/or BW of 2,000 g or less) with regression analysis to determine associations between BW and GA and the development of retinopathy of prematurity (ROP). As BW and GA decreased, the relative risk of developing ROP increased. The relative risk of developing any stage of ROP in infants born at 29 weeks or younger was 2.91 (95% CI: 1.55 to 5.44; P < .001] compared to older infants. The relative risk of developing any type of ROP in infants with BW of less than 1,200 g was 2.41 (95% CI: 1.35 to 4.29; P = .003] and developing type 2 or worse ROP was 2.05 (95% CI: 0.99 to 4.25; P = .05). Infants in Mongolia with heavier BW and older GA who fall outside of current United States screening guidelines of GA of 30 weeks or younger and/or BW of 1,500 g or less developed clinically relevant ROP. [J Pediatr Ophthalmol Strabismus. 2020;57(5):333-339.].

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.

Telemedical Diagnosis of Stage 4 and Stage 5 Retinopathy of Prematurity

To determine the accuracy of image-based diagnosis for stage 4 or worse retinopathy of prematurity (ROP) disease. Prospective cohort study. We prospectively obtained data, from 8 major ROP centers, for 1220 eye examinations from 230 infants. An ophthalmologist at each center provided a clinical diagnosis using indirect ophthalmoscopy. Wide-angle retinal images (RetCam; Clarity Medical Systems, Pleasanton, CA) were then obtained, and these were independently read by 2 ROP experts using a web-based system for an image-based diagnosis. Sensitivity and specificity of image-based diagnosis from the ROP experts were calculated using the clinical diagnosis as the reference standard. Of 1220 examinations, 28 (2%) had a clinical diagnosis of stage 4 or worse. Sensitivity and specificity for stage 4 or worse disease were 75% and 99% for expert 1, and 86% and 99% for expert 2. Sensitivity and specificity for the detection of stage 5 disease were 69% and 99% for both experts. There are inconsistencies in the accuracy of image-based diagnosis of stage 4 and stage 5 ROP when compared with the clinical diagnosis.

Validated System for Centralized Grading of Retinopathy of Prematurity: Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study.

Measurable competence derived from comprehensive and advanced training in grading digital images is critical in studies using a reading center to evaluate retinal fundus images from infants at risk for retinopathy of prematurity (ROP). Details of certification for nonphysician trained readers (TRs) have not yet been described. To describe a centralized system for grading ROP digital images by TRs in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study. Multicenter observational cohort study conducted from July 1, 2010, to June 30, 2014. The TRs were trained by experienced ROP specialists and certified to detect ROP morphology in digital retinal images under supervision of an ophthalmologist reading center director. An ROP reading center was developed with standard hardware, secure Internet access, and customized image viewing software with an electronic grading form. A detailed protocol for grading was developed. Based on results of TR gradings, a computerized algorithm determined whether referral-warranted ROP (RW-ROP; defined as presence of plus disease, zone I ROP, and stage 3 or worse ROP) was present in digital images from infants with birth weight less than 1251 g enrolled from May 25, 2011, through October 31, 2013. Independent double grading was done by the TRs with adjudication of discrepant fields performed by the reading center director. Digital retinal images. Intragrader and intergrader variability and monitoring for temporal drift. Four TRs underwent rigorous training and certification. A total of 5520 image sets were double graded, with 24.5% requiring adjudication for at least 1 component of RW-ROP. For individual RW-ROP components, the adjudication rate was 3.9% for plus disease, 12.4% for zone I ROP, and 16.9% for stage 3 or worse ROP. The weighted κ for intergrader agreement (n = 80 image sets) was 0.72 (95% CI, 0.52-0.93) for RW-ROP, 0.57 (95% CI, 0.37-0.77) for plus disease, 0.43 (95% CI, 0.24-0.63) for zone I ROP, and 0.67 (95% CI, 0.47-0.88) for stage 3 or worse ROP. The weighted κ for grade-regrade agreement was 0.77 (95% CI, 0.57-0.97) for RW-ROP, 0.87 (95% CI, 0.67-1.00) for plus disease, 0.70 (95% CI, 0.51-0.90) for zone I ROP, and 0.77 (95% CI, 0.57-0.97) for stage 3 or worse ROP. These data suggest that the e-ROP system for training and certifying nonphysicians to grade ROP images under the supervision of a reading center director reliably detects potentially serious ROP with good intragrader and intergrader consistency and minimal temporal drift.

Influence of Fluorescein Angiography on the Diagnosis and Management of Retinopathy of Prematurity

To examine the influence of fluorescein angiography (FA) on the diagnosis and management of retinopathy of prematurity (ROP). Prospective cohort study. Nine recognized ROP experts (3 pediatric ophthalmologists and 6 retina specialists) interpreted 32 sets (16 color fundus photographs and 16 color fundus photographs paired with the corresponding FA images) of wide-angle retinal images from infants with ROP. All experts independently reviewed the 32 image sets on a secure website and provided a diagnosis and management plan for the case presented, first based on color fundus photographs alone, and then based on color fundus photographs and corresponding FA images. Sensitivity and specificity of the ROP diagnosis (zone, stage, plus disease, and category, i.e., no ROP, mild ROP, type 2 ROP, and ROP requiring treatment) were calculated using a consensus reference standard diagnosis, determined from the diagnosis of the color fundus photographs by 3 experienced readers in combination with the clinical diagnosis based on ophthalmoscopic examination. The κ statistic was used to analyze the average intergrader agreement among experts for the diagnosis of zone, stage, plus disease, and category. Addition of FA to color fundus photography resulted in a significant improvement in sensitivity for diagnosis of stage 3 or worse disease (39.8% vs. 74.1%; P = 0.008), type 2 or worse ROP (69.4% vs. 86.8%; P = 0.013), and pre-plus or worse disease (50.5 vs. 62.6%; P = 0.031). There was a nonsignificant trend toward improved sensitivity for diagnosis of ROP requiring treatment (22.2% vs. 40.3%; P = 0.063). Using the κ statistic, addition of FA to color fundus photography significantly improved intergrader agreement for diagnosis of ROP requiring treatment. Addition of FA to color fundus photography did not affect intergrader agreement significantly for the diagnosis of stage, zone, or plus disease. Compared with color fundus photography alone, FA may improve the sensitivity of diagnosis of ROP by experts, particularly for stage 3 disease. In addition, intergrader agreement for diagnosis of ROP requiring treatment may improve with FA interpretation.

Screening for Retinopathy of Prematurity in China: A Neonatal Units–Based Prospective Study

To analyze the incidence and severity of retinopathy of prematurity (ROP) in China, and to explore the workload implications of applying different criteria. A prospective, neonatal units-based study undertaken in two tertiary level hospitals in Shanghai, China, from January 1, 2010 to December 31, 2012. All infants with birth weight (BW) of 2000 g or less and/or gestational age (GA) of 34 weeks or less were screened for ROP. Retinopathy of prematurity was classified using the international classification, and was treated in accordance with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. A total of 2825 (93.7%) of 3014 eligible infants were screened, and ROP was diagnosed in 503 infants (17.8%). One hundred ninety-one infants (6.8%) had type 1 or worse ROP and were treated with laser or vitrectomy. The mean GA of ROP patients was 29.9 ± 2.1 weeks and their mean BW was 1425 ± 266 g. Infants who needed treatment for ROP had a mean GA of 29.3 ± 2.1 weeks and mean BW of 1331 ± 330 g. Among these treated infants, 18 infants (9.4%) exceeded the United Kingdom's (UK) screening criteria, and 28 (14.7%) exceeded the criteria used in the United States (US). If narrower criteria, as in GA less than or equal to 33 weeks and/or BW less than or equal to 1750 g were adopted, almost 16.9% fewer infants would not have been examined, with no infant missing treatment. Larger, older infants are at risk in China and screening criteria used in the US and UK may not be suitable for China. Further population-based studies are recommended to determine the necessity of modifying the current ROP screening protocol.

Dark-adapted oscillatory potentials in preterm infants with and without retinopathy of prematurity

To describe the appearance and maturation of dark-adapted oscillatory potentials (OPs) in electroretinograms (ERGs) recorded from preterm infants, and to determine any effect of retinopathy of prematurity (ROP). Dark-adapted ERGs were recorded in conjunction with screening for ROP and at outpatient follow-up, using a flash luminance of 11.3 scot cdsm(-2) (4.06 phot cdsm(-2)). Eligible infants were born before 31weeks' gestation and/or weighed ≤1,250grams at birth. Presence or absence of OPs was established for 68 ERG recordings from 38 infants at maturities ranging from 30weeks' postmenstrual age (PMA) to 28weeks' post-term corrected age. 20 infants did not develop ROP, eight developed stage 1, one stage 2 and one stage 3 disease which regressed spontaneously. Eight infants received treatment for threshold ROP. OPs were present in 50% of infants at 36weeks' PMA and in all by 50weeks' PMA. The earliest appearance of OPs was at 30+5 weeks' PMA. Individual OP amplitudes increased and peak time of individual OPs decreased with increasing maturity. For infants with threshold ROP summed OP amplitudes tended to be smaller prior to treatment (6.5 vs 9.9μV, P=0.09) and were significantly smaller by 50weeks' PMA (14 vs 30μV, P=0.007). OP1 was less likely to be present in infants who developed stage 3 or worse ROP (P=0.000). Dark-adapted OPs are recordable in some preterm infants from 30weeks' PMA. Relative suppression of early OPs is a potential marker for developing ROP.

Retinopathy of prematurity: are we missing any infant with retinopathy of prematurity?

AimsTo evaluate incidence of retinopathy of prematurity (ROP) and validity of current ROP screening criteria adopted in the Armed Forces Hospitals.MethodsA retrospective study of ROP indices was carried out in...

Accuracy of retinopathy of prematurity image-based diagnosis by pediatric ophthalmology fellows: Implications for training

To measure the accuracy of image-based retinopathy of prematurity (ROP) diagnosis by pediatric ophthalmology fellows. This was a comparative case series of expert versus nonexpert clinicians in image-based ROP diagnosis. An atlas of 804 retinal images was captured from 248 eyes of 67 premature infants with a wide-angle camera (RetCam-II, Clarity Medical Systems, Pleasanton, CA). Images were uploaded to a study website from which an expert pediatric retinal specialist and five pediatric ophthalmology fellows independently provided a diagnosis (no ROP, mild ROP, type 2 ROP, or treatment-requiring ROP) for each eye. Two different retinal specialists experienced in ROP examination served as additional controls. Primary outcome measures were sensitivity and specificity of image-based ROP diagnosis by fellows compared to a reference standard of image-based interpretation by the expert pediatric retinal specialist. Secondary outcome measure was intraphysician reliability. For detection of mild or worse ROP, the mean (range) sensitivity among the five fellows was 0.850 (0.670-0.962) and specificity was 0.919 (0.832-0.964). For detection of type 2 or worse ROP by fellows, mean (range) sensitivity was 0.527 (0.356-0.709) and specificity was 0.938 (0.777-1.000). For detection of treatment-requiring ROP, mean (range) sensitivity was 0.515 (0.267-0.765) and specificity was 0.949 (0.805-1.00). Pediatric ophthalmology fellows in this study demonstrated high diagnostic specificity in image-based ROP diagnosis; however, sensitivity was lower, particularly for clinically significant disease.

ACCURACY OF RETINOPATHY OF PREMATURITY DIAGNOSIS BY RETINAL FELLOWS

The purpose of this study was to measure the accuracy of retinopathy of prematurity (ROP) diagnosis by retinal fellows. An atlas of 804 retinal images was captured from 248 eyes of 67 premature infants with a wide-angle camera (RetCam-II, Clarity Medical Systems, Pleasanton, CA). Images were uploaded to a study Web site, from which an expert pediatric retinal specialist and 7 retinal fellows independently provided a diagnosis (no ROP, mild ROP, type 2 ROP, or treatment-requiring ROP) for each eye. The sensitivity and specificity of each retinal fellow were calculated and subsequently compared with a reference standard of diagnosis by an expert pediatric retinal specialist. For detection of type 2 or worse ROP by fellows, mean (range) sensitivity was 0.751 (0.512-0.953), and specificity was 0.841 (0.707-0.976). For detection of treatment-requiring ROP, mean (range) sensitivity was 0.914 (0.667-1.000), and specificity was 0.871 (0.678-0.987). In general, fellows showed high accuracy for detecting ROP. However, 3 of 7 fellows achieved <80% sensitivity for diagnosis of type 2 or worse ROP, and 2 of 7 achieved <90% sensitivity for diagnosis of treatment-requiring ROP. This could lead to undermanagement and undertreatment of clinically significant disease and raises potential concerns about the quality of ROP screening examinations performed by less-experienced examiners.

Telemedical diagnosis of retinopathy of prematurity: accuracy of expert versus non-expert graders

Background/aimsTo assess accuracy of telemedical retinopathy of prematurity (ROP) diagnosis by trained non-expert graders compared with expert graders.MethodsEye examinations (n=248) from 67 consecutive infants were captured using wide-angle retinal photography...

Retinopathy of Prematurity Management using Single-Image vs Multiple-Image Telemedicine Examinations

To compare performance of single-image vs multiple-image telemedicine examinations for retinopathy of prematurity (ROP) diagnosis. Prospective comparative study. A total of 248 eyes from 67 consecutive infants underwent wide-angle retinal imaging by a trained neonatal nurse at 31 to 33 weeks and/or 35 to 37 weeks postmenstrual age (PMA) at a single academic institution. Data were uploaded to a web-based telemedicine system and interpreted by three masked retinal specialists. Diagnoses were provided based on single images, and subsequently on multiple images, from both eyes of each infant. Findings were compared to a reference standard of indirect ophthalmoscopy by a pediatric ophthalmologist. Primary outcome measures were recommended follow-up interval, presence of plus disease, presence of type-2 or worse ROP, and presence of visible peripheral ROP. Among the three graders, mean sensitivity/specificity for detection of infants requiring follow-up in less than one week were 0.85/0.93 by single-image examination and 0.91/0.88 by multiple-image examination at 35 to 37 weeks PMA. Mean sensitivity/specificity for detection of infants with type-2 or worse ROP were 0.82/0.95 by single-image examination and 1.00/0.91 by multiple-image examination at 35 to 37 weeks PMA. Mean sensitivity/specificity for detection of plus disease were 1.00/0.86 by single-image examination and 1.00/0.87 by multiple-image examination at 35 to 37 weeks PMA. There were no statistically-significant intragrader differences between accuracy of single-image and multiple-image telemedicine examinations for detection of plus disease. Single-image and multiple-image telemedicine examinations perform comparably for determination of recommended follow-up interval and detection of plus disease. This may have implications for development of screening protocols, particularly in areas with limited access to ophthalmic care.

Telemedical Diagnosis of Retinopathy of Prematurity: Intraphysician Agreement between Ophthalmoscopic Examination and Image-Based Interpretation

To evaluate the intraphysician agreement between ophthalmoscopic examination and image-based telemedical interpretation for retinopathy of prematurity (ROP) diagnosis, when performed by the same expert physician grader.Prospective, nonrandomized, comparative study.Sixty-seven consecutive premature infants who underwent ROP examination at a major university medical center whose parents consented for participation.Infants underwent standard dilated ophthalmoscopy by one of two pediatric ophthalmologists, followed by retinal imaging with a commercially available wide-angle fundus camera by a trained neonatal nurse. Study examinations were performed at 31 to 33 weeks postmenstrual age (PMA) and/or 35 to 37 weeks PMA. Images were uploaded to a Web-based telemedicine system developed by the authors. After a 4- to 12-month period, telemedical interpretations were performed in which each physician graded images from infants upon whom he had initially performed ophthalmoscopic examinations. Diagnoses were classified using an ordinal scale: no ROP, mild ROP, type 2 prethreshold ROP, and treatment-requiring ROP.Absolute intraphysician agreement and kappa statistic between ophthalmoscopic examination and telemedical interpretation were calculated by eye. All intraphysician discrepancies were reviewed, and underlying causes were classified by eye as no ROP identified by ophthalmoscopic examination, no ROP identified by telemedical interpretation, discrepancy about presence of zone 1 ROP, discrepancy about presence of plus disease, or other discrepancy in classification of ROP stage.Absolute intraphysician agreement between ophthalmoscopic examination and telemedical interpretation was 86.3%. The kappa statistic for intraphysician agreement between examinations ranged from 0.657 (substantial agreement) for diagnosis of treatment-requiring ROP to 0.854 (near-perfect agreement) for diagnosis of mild or worse ROP. Among 206 eye examinations (103 infant examinations), there were 28 (13.6%) intraphysician discrepancies in diagnosis, 8 of which resulted from uncertainty about presence of zone 1 disease and 4 from uncertainty about presence of plus disease.Intraphysician agreement between ophthalmoscopic examination and telemedical interpretation for ROP was very high. Neither examination modality appeared to have a systematic tendency to overdiagnose or underdiagnose ROP. Diagnosis of zone 1 disease and plus disease were major sources of clinically significant discrepancies.

Telemedical Retinopathy of Prematurity Diagnosis

To prospectively measure accuracy, reliability, and image quality of telemedical retinopathy of prematurity (ROP) diagnosis. Two-hundred forty-eight eyes from 67 consecutive infants underwent wide-angle retinal imaging by a trained neonatal nurse at 31 to 33 weeks' and/or 35 to 37 weeks' postmenstrual age (PMA) using a standard protocol. Data were uploaded to a Web-based telemedicine system and interpreted by 3 expert retinal specialist graders who provided a diagnosis (no ROP, mild ROP, type 2 prethreshold ROP, treatment-requiring ROP) and an evaluation of image quality for each eye. Findings were compared with a reference standard of indirect ophthalmoscopy by an experienced pediatric ophthalmologist. At 35 to 37 weeks' PMA, sensitivity and specificity for diagnosis of mild or worse ROP were 0.908 and 1.000 for grader A, 0.971 and 1.000 for grader B, and 0.908 and 0.977 for grader C. Sensitivity and specificity for diagnosis of type 2 prethreshold or worse ROP were 1.000 and 0.943 for grader A, 1.000 and 0.930 for grader B, and 1.000 and 0.851 for grader C. At 35 to 37 weeks' PMA, weighted kappa for intergrader reliability was 0.791 to 0.889, and kappa for intragrader reliability for detection of type 2 prethreshold or worse ROP was 0.769 to 1.000. Image technical quality was rated as "adequate" or "possibly adequate" for diagnosis in 93.3% to 100% of eyes. A telemedicine system using nurse-captured retinal images has the potential to improve existing shortcomings of ROP management, particularly at later PMAs.

Incidence, progression, and duration of retinopathy of prematurity in Hispanic and white non-Hispanic infants

To compare the incidence, progression, and duration of retinopathy of prematurity (ROP) in low-birth-weight Hispanic and white non-Hispanic infants. A total of 671 white non-Hispanic infants and 128 Hispanic infants with birth weights less than 1751 g were retrospectively evaluated to determine the incidence of both ROP and subthreshold or worse ROP. Multiple regression analysis was used to control for birth weight, gestational age at birth, year of birth, and newborn intensive care unit as contributing factors in the risk of ROP. The duration of ROP in untreated infants was calculated and compared for the two ethnic groups. There was no significant difference in the percentage of infants with ROP in the white non-Hispanic group (38.3%) versus the Hispanic group (41.4%). There was also no significant difference between white non-Hispanics (11.8%) and Hispanics (15.6%) in the risk of developing subthreshold or worse ROP. Multiple regression analysis showed no contribution of ethnicity to the risk of developing ROP (t = -0.34, p = 0.74) or subthreshold or worse ROP (t = 0.75, p = 0.45). The average duration of untreated ROP in white non-Hispanics (8.6 +/- 5.4 weeks) and Hispanics (8.9 +/- 7.0 weeks) also was not significantly different. However, Hispanic infants showed significantly higher variance in duration than white non-Hispanic infants (p = 0.04). ROP occurs with similar frequency in Hispanic and white non-Hispanic premature infants, as does subthreshold or worse ROP. Some Hispanic infants had an unusually short or long duration of ROP before regression, implying that the natural history of ROP may be somewhat different for the two ethnic groups.