Screening for retinopathy of prematurity (ROP) using wide-angle digital retinal photography by non-ophthalmologists: a systematic review

Abstract

Retinopathy of prematurity (ROP) is one of the leading and preventable causes of blindness. The investigation of choice for diagnosing ROP is binocular indirect ophthalmoscope (BIO) done by ophthalmologists. Since the number of ophthalmologists available to do BIO examination is limited, especially in developing countries, there is a need for an alternate, cheap, reliable and feasible test. Telemedicine imaging with Digital Retinal Photography (DRP) is one such alternate diagnostic test which can be performed easily by non-ophthalmologists, with adequate training. Our objective was to conduct a systematic review to evaluate the accuracy of DRP performed by trained personnel (non-ophthalmologists) in diagnosing clinically significant ROP. Medline, EMBASE, CINAHL and Cochrane databases were searched independently by two authors. Eligible studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. Six were included in the review (three prospective; N=120, three retrospective; N=579). Studies had methodological limitations on QUADAS-2. Because of the heterogeneity of studies, data could not be pooled to derive single-effect size estimates for sensitivity and specificity. The included studies reported sensitivity of 45.5-100% with the majority being more than 90%; specificity 61.7-99.8% with the majority being more than 90%, positive predictive value 61.5-96.6% and negative predictive value of 76.9-100% for diagnosing clinically significant ROP. We conclude that diagnostic accuracy of DRP must be established in prospective studies with adequate sample size where DRP is compared against the simultaneously performed BIO examination.

Risk factors for hypertensive retinopathy in a Chinese population with hypertension: The Beijing Eye study

“…Disc/nasal field: Where the optic disc is positioned one disc-diameter in from the temporal edge of the field on the horizontal meridian. The details of the macular and disc/nasal field, and the method of ophthalmologic examination were as described previously (17). Keithy-Wagener grading standards (18) was used for fundus grading: Level I was defined as retinal artery thinning with reflective enhancement; Level II demonstrated retinal artery stenosis and arteriovenous cross oppression; Level III was based on the vascular lesions of level I and II, with cotton-like exudate; and Level IV was allocated on the basis of optic disc edema.…”

Real‐time teleophthalmology video consultation: an analysis of patient satisfaction in rural Western Australia

“…Scientific evaluation of teleophthalmology has largely revolved around the assessment of the clinical efficacy and feasibility of the medium in its various applications . Limited studies have investigated patient satisfaction with real‐time teleophthalmological programs and to our knowledge, no prior study has specifically focused on this as the primary outcome .…”

Intereye Agreement of Retinopathy of Prematurity from Image Evaluation in the Telemedicine Approaches to Evaluating of Acute-Phase ROP (e-ROP) Study

“…8 Telemedicine approaches to ROP have been evaluated in United States and other countries, and showed promise for use in the delivery of health care for premature infants. 9–14 …”