Telemedicine improves ROP management

A telemedicine system using nurse-captured retinal images could potentially improve retinopathy of prematurity (ROP) management, according to a report published in the November issue of Archives of Ophthalmology.

Michael Chiang from Columbia University of Physicians and Surgeons and colleagues from centres across the US conducted a study to measure the accuracy, reliability and image quality of telemedical ROP diagnosis.

A total of 248 eyes from 67 consecutive infants underwent wide-angle retinal imaging by a trained neonatal nurse at 31 to 33 weeks and/or 35 to 37 weeks postmenstrual age (PMA). Data was uploaded to a web-based telemedicine system and interpreted by three retinal specialist graders who provided a diagnosis (no ROP, mild ROP, type 2 pre-threshold ROP or treatment-requiring ROP) and an evaluation of image quality for each eye. Findings were compared with a reference standard of indirect ophthalmoscopy by an experienced paediatric ophthalmologist.

At 35 to 37 weeks PMA, sensitivity and specificity for diagnosis of mild or worse ROP were 0.908 and 1.000 for grader A, 0.971 and 1.000 for grader B and 0.908 and 0.977 for grader C. Sensitivity and specificity for diagnosis of type 2 pre-threshold or worse ROP were 1.000 and 0.943 for grader A, 1.000 and 0.930 for grader B and 1.000 and 0.851 for grader C. Image technical quality was rated as "adequate" or "possibly adequate" for diagnosis in 93.3% to 100% of eyes.

It is thought that a telemedicine system could help improve ROP management.