A Comparison of Strategies for Retinopathy of Prematurity Detection

Kemper, Alex R.; Prosser, Lisa A.; Wade, Kelly C.; Repka, Michael X.; Ying, Gui‐Shuang; Baumritter, Agnieshka; Quinn, Graham E.

doi:10.1542/peds.2015-2256

Cited by 17 publications

(16 citation statements)

References 22 publications

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“…Adverse events were more likely to occur when the infant was on mechanical ventilation, regardless of whether the procedure was an eye examination or retinal imaging. Noteworthy clinical findings such as apnea greater than 10 seconds and severe bradycardia or tachypnea were more common than adverse events and the proportion was consistent with other smaller studies on fragile extremely premature infants (Wade et al, 2015) Based on the findings of the e-ROP study, e-ROP investigators (Kemper et al, 2016) compared digital imaging strategies with bedside serial examinations. Using a microsimulation approach of a cohort of infants with gestational ages from 23-30 weeks GA (microsimulation being a technique to evaluate the outcomes from competing policies by statistically modeling the experience of individuals within a hypothetical cohort), they reported that all cases of type 1 ROP were detected using digital imaging in combination with an ROP examination at discharge.…”

Section: Telemedicine and Rop Screeningsupporting

confidence: 80%

Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective

Chan‐Ling

Gole

Quinn

et al. 2018

Progress in Retinal and Eye Research

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107

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The population of infants at risk for retinopathy of prematurity (ROP) varies by world region; in countries with well developed neonatal intensive care services, the highest risk infants are those born at less than 28 weeks gestational age (GA) and less than 1 kg at birth, while, in regions where many aspects of neonatal intensive and ophthalmological care are not routinely available, more mature infants up to 2000 g at birth and 37 weeks GA are also at risk for severe ROP. Treatment options for both groups of patients include standard retinal laser photocoagulation or, more recently, intravitreal anti-VEGF drugs. In addition to detection and treatment of ROP, this review highlights new opportunities created by telemedicine, where screening and diagnosis of ROP in remote locations can be undertaken by non-ophthalmologists using digital fundus cameras. The ophthalmological care of the ROP infant is undertaken in the wider context of neonatal care and general wellbeing of the infant. Because of this context, this review takes a multi-disciplinary perspective with contributions from retinal vascular biologists, pediatric ophthalmologists, an epidemiologist and a neonatologist. This review highlights the latest insights regarding cellular and molecular mechanisms in the formation of the retinal vasculature in the human infant, pathogenesis of ROP, detection and treatment of severe ROP, the risks and benefits of anti-VEGF therapy, the identification of new therapies over the horizon, and the optimal neonatal care regimen for best ROP outcomes, and the benefits and pitfalls of telemedicine in the remote screening and diagnosis of ROP, all of which have the potential to improve ROP outcomes.

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Section: Telemedicine and Rop Screeningsupporting

confidence: 80%

Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective

Chan‐Ling

Gole

Quinn

et al. 2018

Progress in Retinal and Eye Research

Self Cite

126

107

View full text Add to dashboard Cite

show abstract

“…In the CRYO-ROP study, experts disagreed on the presence or absence of threshold disease for 12% of the cases, particularly regarding the presence or absence of plus disease 27. While standard retinal examinations are performed by indirect ophthalmoscopy, digital imaging is being increasingly employed, either at the same time (to serve as a permanent record) or alone (to be interpreted locally or remotely) 28. Nonetheless, digital photographs still require interpretation and may be subject to bias.…”

Section: Discussionmentioning

confidence: 99%

International variations and trends in the treatment for retinopathy of prematurity

et al. 2017

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Objective To compare the rates of retinopathy of prematurity (ROP) and treatment of ROP by laser or intravitreal anti-vascular endothelial growth factor among preterm neonates from high-income countries participating in the International Network for Evaluating Outcomes (iNeo) of neonates. Methods A retrospective cohort study was conducted on extremely preterm infants weighing <1500 g at 24 0 to 27 6 weeks' gestation who were admitted to neonatal units in Australia/New Zealand, Canada, Finland, Israel, Japan, Spain, Sweden, Switzerland, Tuscany (Italy) and the UK between 2007 and 2013. Pairwise comparisons of ROP treatment in survivors between countries were evaluated by Poisson and multivariable logistic regression analyses after adjustment for confounders. A composite outcome of death or ROP treatment was compared between countries using logistic regression and standardised ratios. Results Of 48 087 infants included in the analysis, 81.8% survived to 32 weeks postmenstrual age, and 95% of survivors were screened for ROP. Rates of any ROP ranged from 25.2% to 91.0% in Switzerland and Japan, respectively, among those examined. The overall rate of those receiving treatment was 24.9%, which varied from 4.3% to 30.4%. Adjusted risk ratios for ROP treatment were lower for Switzerland in all pairwise comparisons, whereas Japan displayed significantly higher ratios. Comparisons of the composite outcome between countries revealed similar, but less marked differences. Conclusions Rates of any ROP and ROP treatment varied significantly between iNeo members, while an overall decline in ROP treatment was observed during the study period. It is unclear whether these variations represent differences in care practices, diagnosis and/or treatment thresholds.

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“…A few key barriers that hinder direct examination by ophthalmoscopy are decentralization of neonatal intensive care units (NICUs), low reimbursement, and high ROP malpractice awards. 7,8 In 2015, the American Academy of Pediatrics and the American Academy of Ophthalmology released a joint systematic review of the tele-ROP literature. The 11 studies ultimately reviewed featured independent masked comparison of a cohort of subjects examined with both wide-angle digital retinal photography and reference standard ophthalmoscopic examination.…”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

The Current State of Teleophthalmology in the United States

et al. 2017

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Telemedicine services facilitate the evaluation, diagnosis, and management of the remote patient. Telemedicine has rapidly flourished in the United States and has improved access to care, outcomes, and patient satisfaction. However, the use of telemedicine in ophthalmology is currently in its infancy and has yet to gain wide acceptance. Current models of telemedicine in ophthalmology are largely performed via “store and forward” methods, but remote monitoring and interactive modalities exist. Although studies have examined the effects of telemedicine, few reports have characterized its current status. We perform a descriptive analysis of the current state of teleophthalmology in the United States. We describe the use of teleophthalmology in the hospital and outpatient settings. We also review the applications to retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, and glaucoma, as well as anticipated barriers and hurdles for the future adoption of teleophthalmology. With ongoing advances in teleophthalmology, these models may provide earlier detection and more reliable monitoring of vision-threatening diseases.

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A Comparison of Strategies for Retinopathy of Prematurity Detection

Cited by 17 publications

References 22 publications

Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective

Pathophysiology, screening and treatment of ROP: A multi-disciplinary perspective

International variations and trends in the treatment for retinopathy of prematurity

The Current State of Teleophthalmology in the United States

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