Telemedicine for Retinopathy of Prematurity in 2020

Abstract

Purpose: Retinopathy of prematurity (ROP) is the leading cause of visual impairment in premature infants, and middle-income nations are currently experiencing the “third epidemic” of ROP. Screening programs are essential to prevent negative visual outcomes, but screening efforts require a great amount of resources from healthcare systems and are difficult to marshal, particularly in geographically isolated or resource-limited settings. Telemedical screening programs using remote digital fundus imaging (RDFI) systems hold the promise of alleviating many of the burdens that currently make screening for ROP logistically challenging. Methods: Literature review of the current evidence for RDFI telescreening for ROP, with editorial discussion and recommendations. Results: In this review, we summarize the robust body of literature regarding the efficacy of RDFI, the feasibility of telescreening programs, and experiences from current live telescreening programs. We discuss the strengths and limitations of the current evidence and of the screening programs and consider the best practices in developing de novo telemedical screening programs for ROP. The review concludes with a discussion of promising future areas of research and development. Conclusions: RDFI ROP screening programs can be accurate and reliable. They show promise in improving many current challenges in screening infants for ROP, may be able to improve some aspects of care, and have been demonstrated to be cost-effective.

80 Years of vision: preventing blindness from retinopathy of prematurity

“…While treatment success may be somewhat influenced by the therapeutic modalities of choice, success is primarily dependent on the timing of intervention, close monitoring, timely re-treatment when indicated, follow-up past NICU discharge, and in cases with persistent ROP and prior anti-VEGF therapy, strong consideration for fluorescein angiography and laser therapy even in the absence of ongoing Type 1 ROP. In addition, the increasing availability of genetic testing may offer guidance in the surveillance and treatment of ROP, and telemedicine may allow for improved management of ROP [ 67 ].…”

Color fundus imaging in retinopathy of prematurity screening

“…Its field of view is 120°, and it provides a complete circular image with a resolution of 2040*2040, costing approximately 25,000 USD. [ 1 , 9 ] The probe is lighter compared to RetCam, with an option of live zoom. It is compatible with pigmented fundus and has less of false colors.…”

“…Lack of standard guidelines for imaging as a screening modality will itself pose a challenge regarding the frequency of repeating the imaging, imaging modality, and techniques to be used. [ 1 ] In underdeveloped and developing countries, deficiency of ROP specialists leads to underscreening and late referrals from remote areas. Use of fundus imaging as a screening device which can be easily handled by trained paramedics helps in developing telescreening platforms which would cover wide range of rural areas with limited number of available specialists.…”

“…A good documentation of findings of initial and follow-up visits can also help avoid the clinicians from getting into legal liabilities. [ 1 , 2 ] The aim of this article is to summarize the features of existing and upcoming neonatal color fundus imaging devices and various ROP telescreening modules in ROP, which can aid in implementation of telescreening as a standard screening protocol for ROP across developing and developed countries.…”

The Role of Telemedicine to Alleviate an Increasingly Burdened Healthcare System: Retinopathy of Prematurity

“…Digital fundus images obtained by trained photographers are sent to a remote location for analysis by an ophthalmologist or a trained grader. Bedside examination would then be limited to cases of poor image readability and cases with high-risk features requiring treatment [8].…”