SUNDROP: six years of screening for retinopathy of prematurity with telemedicine

Wang, Sean K.; Callaway, Natalia F.; Wallenstein, Matthew B.; Henderson, Michael T.; Leng, Theodore; Moshfeghi, Darius M.

doi:10.1016/j.jcjo.2014.11.005

Cited by 141 publications

(101 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A retrospective analysis at the Stanford University program demonstrated sensitivity and specificity approaching 100%, without any adverse events in more than 1000 eyes. 12 …”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

The Current State of Teleophthalmology in the United States

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

“…A retrospective analysis at the Stanford University program demonstrated sensitivity and specificity approaching 100%, without any adverse events in more than 1000 eyes. 12 …”

Section: Hospital-based Evaluationsmentioning

confidence: 99%

The Current State of Teleophthalmology in the United States

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Recent studies have shown that telemedicine for ROP screening can be safe and effective. 4–9 Our “Telemedicine approaches to evaluating acute-phase retinopathy of prematurity” (e-ROP) Study demonstrated that a telemedicine system using non-physician imagers and non-physician trained readers for detection of referral-warranted ROP (RW-ROP, defined as Zone I disease, Stage 3 disease or worse, or plus disease) is valid, safe and cost-effective. 5;10–12 …”

Section: Introductionmentioning

confidence: 99%

Risk Score for Predicting Treatment-Requiring Retinopathy of Prematurity (ROP) in the Telemedicine Approaches to Evaluating Acute-Phase ROP Study

et al. 2016

View full text Add to dashboard Cite

Purpose To develop a risk score for predicting treatment-requiring ROP (TR-ROP) as determined by study-certified ophthalmologists in the e-ROP study. Design Second Analyses of an observational cohort study. Participants Infants with birth weight <1251g who had at least one imaging session by 34 weeks of postmenstrual age (PMA) and at least one subsequent ROP examination for determining TR-ROP by study-certified ophthalmologists. Methods Non-physician trained readers evaluated wide-field retinal image sets for characteristics of ROP, pre-plus/plus disease and retinal hemorrhage. Risk score points for predicting TR-ROP were derived from the regression coefficients of significant predictors in a multivariate logistic regression model. Results Among 771 infants, 85 (11.0%) developed TR-ROP. In a multivariate model, significant predictors [odds ratio (95% confidence interval)] for TR-ROP were: gestational age (GA) [5.7 (1.7 – 18.9) for ≤25 vs. ≥28 weeks], need for respiratory support [7.0 (1.3 – 37.1) for high frequency oscillatory ventilation vs. no respiratory support], slow weight gain [2.4 (1.2 – 4.6) for weight gain ≤12g/day vs. >15g/day], and image findings at the first image session including: number of quadrants with pre-plus [3.8 (1.5 – 9.7) for 4 pre-plus quadrants vs. no pre-plus], stage and zone of ROP [4.7 (2.1 – 11.8) for stage 1–2 zone I, 5.9 (2.1 – 16.6) for stage 3 zone I vs. no ROP], and presence of blot hemorrhage [3.1 (1.4 – 6.7)]. Image findings predicted TR-ROP better than GA (area under ROC curve [AUC] =0.82 vs. 0.75, p=0.03). The 22-point risk score derived from 6 significant predictors had a median of 4 points (range: 0 to 18). The risk of TR-ROP steadily increased with higher risk score (0% for 0 point, 1–8% for 1–5 points, 12–27% for 6–10 points, 43% for 11–13 points and 94% for 14 points or above), and predicted TR-ROP well (AUC=0.88, 95% CI: 0.85–0.92). Risk score ≥3 points for predicting TR-ROP had sensitivity 98.8%, specificity 40.1%, positive and negative predictive values of 17.0% and 99.6% respectively. Conclusions Image characteristics at 34 PMA weeks or earlier independently predict TR-ROP. If externally validated in other infants, risk score, calculated from image findings, GA, weight gain and respiratory support, enables early identification of infants in need of increased surveillance for TR-ROP.

show abstract

“…The efficacy of teleretinal screening for ROP using RetCam has been validated in several studies. [27][28][29][35][36][37][38][39][40][41]44 Notably, the Recently, the multicenter Telemedicine Approaches to Evaluating AcutePhase Retinopathy of Prematurity (e-ROP) study created a grading system for digital ROP images, where nonphysicians were successfully trained to grade and screen for patients with referral-warranted ROP. 45 These findings suggest that telemedicine appears to be a safe, reliable, and cost-effective complement to direct examinations by ROP specialists, with the potential to increase screening and extend treatment to infants with vision-threatening disease.…”

Section: Pediatric Retinal Diseasesmentioning

confidence: 99%

Wide-field Imaging of Retinal Diseases

Kim¹,

Moshfeghi²

2015

US Ophthalmic Review

View full text Add to dashboard Cite

125Retinal imaging serves as a critical adjunct to the diagnosis, monitoring, and treatment of numerous ocular diseases. Since the invention of the direct ophthalmoscope by Hermann von Helmholtz in 1851, techniques to visualize the fundus have grown exponentially both in number and sophistication. Notably, wide-field retinal imaging has taken center stage over the past 2 decades. Given its increasing popularity in research and clinical use, it is important to be aware of the different types of wide-field imaging currently available, as well as the clinical applications for, advantages, and limitations of widefield retinal imaging. This review article aims to highlight our current understanding of wide-field retinal imaging and provide an outlook for its future implications. Historical PerspectiveThe first fundus camera was developed by Frederick Dimmer at the turn of the 20th century. Dimmer was the first to incorporate fundus photography into an ophthalmic textbook, and he published the first photographic atlas in black-and-white. AbstractRetinal imaging serves as a critical adjunct to the diagnosis, monitoring, and treatment of numerous ocular diseases. In particular, wide-field retinal imaging is quickly moving to the forefront in imaging the posterior segment. While conventional fundus imaging captures 30 to 50° field of view in a single capture, significant advances have been made in the past 2 decades to increase the viewing angle, speed, and accuracy of fundus photography, such that a single-field capture is now up to 200°. Moreover, multiple imaging modalities, including color fundus photography, fluorescein angiography, and autofluorescence, are now available a single wide-field imaging platform. This breadth of functionality makes wide-field imaging especially useful in peripheral retinal vascular diseases, such as diabetic retinopathy, posterior uveitis, and retinopathy of prematurity. This review aims to provide a historical perspective on wide-field retinal imaging, highlight the imaging platforms currently available, discuss the advantages and disadvantages of wide-field versus conventional fundus imaging, summarize the current clinical applications of wide-field retinal imaging, and provide an outlook for its future implications. KeywordsWide-field imaging, ultra-wide-field imaging, retinal imaging, Optos, Heidelberg, fluorescein angiography, autofluorescence, diabetic retinopathy, retinal vein occlusion, retinopathy of prematurity Disclosure: Esther Kim, MD, has no relevant conflicts of interest to declare. Andrew A Moshfeghi, MD, MBA, has been a consultant

show abstract

SUNDROP: six years of screening for retinopathy of prematurity with telemedicine

Cited by 141 publications

References 35 publications

The Current State of Teleophthalmology in the United States

The Current State of Teleophthalmology in the United States

Risk Score for Predicting Treatment-Requiring Retinopathy of Prematurity (ROP) in the Telemedicine Approaches to Evaluating Acute-Phase ROP Study

Wide-field Imaging of Retinal Diseases

Contact Info

Product

Resources

About