Telemedicine for Evaluation of Retinopathy of Prematurity

Fierson, Walter M.; Capone, Antonio; Granet, David B.; Blocker, Richard J.; Bradford, G. E.; Lehman, FAAP. Sharon S.; Rubin, Steven E.; Siatkowski, R. Michael; Ruben, James B.

doi:10.1542/peds.2014-0978

Cited by 141 publications

(76 citation statements)

References 26 publications

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“…Further, the definition of RW-ROP is set sufficiently low to capture eyes requiring treatment prior to the presence of type 1 ROP. The joint technical report on Telemedicine for Evaluation of Retinopathy of Prematurity recently published by the American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, and American Association of Certified Orthoptists 28 is a step toward developing a standard approach to ROP telemedicine. Further refinements in ROP image grading are needed.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

et al. 2016

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IMPORTANCEAs effective treatments for potentially blinding retinopathy of prematurity (ROP) have been introduced, the importance of consistency in findings has increased, especially with the shift toward retinal imaging in infants at risk of ROP.OBJECTIVE To characterize discrepancies in findings of ROP between digital retinal image grading and examination results from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity study, conducted from May 2011 to October 2013. DESIGN, SETTING, AND PARTICIPANTSA poststudy consensus review of images was conducted by 4 experts, who examined discrepancies in findings between image grades by trained nonphysician readers and physician examination results in infants with referral-warranted ROP (RW-ROP). Images were obtained from 13 North American neonatal intensive care units from eyes of infants with birth weights less than 1251 g. For discrepancy categories with more than 100 cases, 40 were randomly selected; in total, 188 image sets were reviewed. MAIN OUTCOMES AND MEASURESConsensus evaluation of discrepant image and examination findings for RW-ROP components. RESULTS Among 5350 image set pairs, there were 161 instances in which image grading did not detect RW-ROP noted on clinical examination (G−/E+) and 854 instances in which grading noted RW-ROP when the examination did not (G+/E−). Among the sample of G−/E+ cases, 18 of 32 reviews (56.3%) agreed with clinical examination findings that ROP was present in zone I and 18 of 40 (45.0%) agreed stage 3 ROP was present, but only 1 of 20 (5.0%) agreed plus disease was present. Among the sample of G+/E− cases, 36 of 40 reviews (90.0%) agreed with readers that zone I ROP was present, 23 of 40 (57.5%) agreed with readers that stage 3 ROP was present, and 4 of 16 (25.0%) agreed that plus disease was present. Based on the consensus review results of the sampled cases, we estimated that review would agree with clinical examination findings in 46.5% of the 161 G−/E+ cases (95% CI, 41.6-51.6) and agree with trained reader grading in 70.0% of the 854 G+/E− cases (95% CI, 67.3-72.8) for the presence of RW-ROP.CONCLUSIONS AND RELEVANCE This report highlights limitations and strengths of both the remote evaluation of fundus images and bedside clinical examination of infants at risk for ROP. These findings highlight the need for standardized approaches as ROP telemedicine becomes more widespread.

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Section: Discussionmentioning

confidence: 99%

Analysis of Discrepancy Between Diagnostic Clinical Examination Findings and Corresponding Evaluation of Digital Images in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study

et al. 2016

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“…of tele-echocardiography (20)(21)(22), tele-dermatology (23,24), and tele-retinal screening (25). Remote patient monitoring involves the transmission of personal health and medical data allowing a provider to track healthcare data, such as symptoms, vital signs, and/or laboratory data.…”

Section: Overview Of Telemedicinementioning

confidence: 99%

“…As telemedicine becomes easier to implement using personal computers, pilot studies in California and Utah have reported linking families by remote access to bedside rounds and nursing caregivers. Telemedicine may also allow for earlier transfer back to a rural step-down nursery by providing telemedicine screening for specific conditions such as retinopathy of prematurity (25).…”

Section: Perinatal and Newborn Carementioning

confidence: 99%

Addressing health disparities in rural communities using telehealth

2015

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The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists' geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.

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“…[8][9][10][11] Telemedicine has been used to address these challenges in delivery of care, and computer-based image analysis could complement these systems. [12][13][14][15] There have been numerous studies on computeraided quantification of vascular features in ROP. [13][14][15] However, previous studies have had several limitations: (1) Little work to our knowledge has focused on comparative analysis to identify image features that are most important for diagnosis.…”

Section: Introductionmentioning

confidence: 99%