Top

Graefe's Archive for Clinical and Experimental Ophthalmology

Published in:

01-01-2009 | Pediatrics

Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 18-month experience with telemedicine screening

Authors: Ruwan A. Silva, Yohko Murakami, Atul Jain, Jarel Gandhi, Eleonora M. Lad, Darius M. Moshfeghi

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 1/2009

Abstract

Purpose

To report the 18-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.

Design

Retrospective analysis of the SUNDROP archival data between 1 December 2005 and 30 May 2007, evaluating this new diagnostic technology for ROP screening.

Participants

All 97 consecutively enrolled infants in the SUNDROP network.

Methods

All patients were screened using the RetCam II, and evaluated by the SUNDROP reading center at Stanford University. Nurses were trained to obtain five images in each eye. All patients were screened by an ophthalmologist trained in diagnosing ROP within 1 week of discharge from the hospital.

Main outcome measures

Outcomes included referral-warranted disease, need for treatment, and anatomic outcomes. Referral-warranted disease was defined as any Early Treatment Retinopathy of Prematurity Disease Type 2 or greater, threshold disease, any plus disease, and any stage 4 or higher disease.

Results

In the initial 18-month period, the SUNDROP telemedicine screening initiative has not missed any referral-warranted disease for ROP. A total of 97 infants (194 eyes) were enrolled, resulting in 443 unique examinations and 4,929 unique images. The mean birth weight of the infants was 1,186.9 grams, with a mean gestational age at birth of 28.9 weeks. Seven infants were identified with referral-warranted disease; six patients underwent laser photocoagulation and completely regressed. The one remaining patient regressed spontaneously, and did not require intervention. Calculated sensitivity and specificity was 100% and 98.9% respectively. No patient progressed to retinal detachment or other adverse outcome. Inadequate exposure, artifact, poor visualization of the periphery, and lack of a complete standardized image set in some patients were identified as areas requiring further assessment.

Conclusions

The SUNDROP telemedicine screening initiative for ROP has proven to have a high degree of sensitivity and specificity for identification of referral-warranted disease. Training was easily implemented. All cases of referral-warranted disease were captured. There were no adverse outcomes.

Quiram PA, Capone A Jr (2007) Current understanding and management of retinopathy of prematurity. Curr Opin Ophthalmol 18(3):228–234, doi:10.1097/ICU.0b013e3281107fd3 PubMedCrossRef

News NIH, National Eye Institute. Early treatment of blinding eye disease in infants can prevent severe vision loss. December 8, 2003; www.nei.nih.gov/rop.

Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (2001) Ophthalmological outcomes at 10 years. Arch Ophthalmol 119(8):1110–1118

Axer-Siegel R, Snir M, Cotlear D et al (2000) Diode laser treatment of posterior retinopathy of prematurity. Br J Ophthalmol 84(12):1383–1386. doi:10.1136/bjo.84.12.1383 PubMedCrossRef

Banach MJ, Ferrone PJ, Trese MT (2000) A comparison of dense versus less dense diode laser photocoagulation patterns for threshold retinopathy of prematurity. Ophthalmology 107(2):324–327 discussion 328. doi:10.1016/S0161–6420(99)00042–1 PubMedCrossRef

Coats DK, Miller AM, Brady McCreery KM et al (2004) Involution of threshold retinopathy of prematurity after diode laser photocoagulation. Ophthalmology 111(10):1894–1898. doi:10.1016/j.ophtha.2004.02.005 PubMedCrossRef

Coats DK, Miller AM, Hussein MA et al (2005) Involution of retinopathy of prematurity after laser treatment: factors associated with development of retinal detachment. Am J Ophthalmol 140(2):214–222. doi:10.1016/j.ajo.2004.12.106 PubMedCrossRef

Connolly BP, Ng EY, McNamara JA et al (2002) A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: part 2. Refractive outcome. Ophthalmology 109(5):936–941. doi:10.1016/S0161–6420(01)01015–6 PubMedCrossRef

Early Treatment For Retinopathy Of Prematurity Cooperative G (2003) Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol 121(12):1684–1694. doi:10.1001/archopht.121.12.1684

10.

Ng EY, Connolly BP, McNamara JA et al (2002) A comparison of laser photocoagulation with cryotherapy for threshold retinopathy of prematurity at 10 years: part 1. Visual function and structural outcome. Ophthalmology 109(5):928–934 discussion 935. doi:10.1016/S0161–6420(01)01017-X PubMedCrossRef

11.

Rezai KA, Eliott D, Ferrone PJ, Kim RW (2005) Near confluent laser photocoagulation for the treatment of threshold retinopathy of prematurity. Arch Ophthalmol 123(5):621–626. doi:10.1001/archopht.123.5.621 PubMedCrossRef

12.

American Academy of Pediatrics. Section on Ophthalmology (2001) Screening examination of premature infants for retinopathy of prematurity. Pediatrics 108(3):809–811. doi:10.1542/peds.108.3.809 CrossRef

13.

American Academy of Pediatrics. Section on Ophthalmology (2006) Screening examination of premature infants for retinopathy of prematurity. Pediatrics 117(2):572–576. doi:10.1542/peds.2005–2749 CrossRef

14.

Roth DB, Morales D, Feuer WJ et al (2001) Screening for retinopathy of prematurity employing the retcam 120: sensitivity and specificity. Arch Ophthalmol 119(2):268–272PubMed

15.

Wright K, Anderson ME, Walker E, Lorch V (1998) Should fewer premature infants be screened for retinopathy of prematurity in the managed care era? Pediatrics 102(1 Pt 1):31–34. doi:10.1542/peds.102.1.31 PubMedCrossRef

16.

Laws DE, Morton C, Weindling M, Clark D (1996) Systemic effects of screening for retinopathy of prematurity. Br J Ophthalmol 80(5):425–428. doi:10.1136/bjo.80.5.425 PubMedCrossRef

17.

Bashshur RL, Reardon TG, Shannon GW (2000) Telemedicine: a new health care delivery system. Annu Rev Public Health 21:613–637. doi:10.1146/annurev.publhealth.21.1.613 PubMedCrossRef

18.

Grigsby J, Sanders JH (1998) Telemedicine: where it is and where it’s going. Ann Intern Med 129(2):123–127PubMed

19.

Schwartz SD, Harrison SA, Ferrone PJ, Trese MT (2000) Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera. Ophthalmology 107(1):25–28. doi:10.1016/S0161–6420(99)00003–2 PubMedCrossRef

20.

Yen KG, Hess D, Burke B et al (2000) The optimum time to employ telephotoscreening to detect retinopathy of prematurity. Trans Am Ophthalmol Soc 98:145–150, discussion 150–151PubMed

21.

Yen KG, Hess D, Burke B et al (2002) Telephotoscreening to detect retinopathy of prematurity: preliminary study of the optimum time to employ digital fundus camera imaging to detect ROP. J AAPOS 6(2):64–70. doi:10.1067/mpa.2002.121616 PubMedCrossRef

22.

Chiang MF, Keenan JD, Du YE et al (2005) Assessment of image-based technology: impact of referral cutoff on accuracy and reliability of remote retinopathy of prematurity diagnosis. AMIA Annu Symp Proc:126–130

23.

Chiang MF, Keenan JD, Starren J et al (2006) Accuracy and reliability of remote retinopathy of prematurity diagnosis. Arch Ophthalmol 124(3):322–327. doi:10.1001/archopht.124.3.322 PubMedCrossRef

24.

Flynn JT (1985) An international classification of retinopathy of prematurity. Clinical experience. Ophthalmology 92(8):987–994PubMed

25.

Javitt J, Dei Cas R, Chiang YP (1993) Cost-effectiveness of screening and cryotherapy for threshold retinopathy of prematurity. Pediatrics 91(5):859–866PubMed

26.

Lorenz B, Bock M, Muller HM, Massie NA (1999) Telemedicine based screening of infants at risk for retinopathy of prematurity. Stud Health Technol Inform 64:155–163PubMed

27.

Mehta M, Adams GG, Bunce C et al (2005) Pilot study of the systemic effects of three different screening methods used for retinopathy of prematurity. Early Hum Dev 81(4):355–360. doi:10.1016/j.earlhumdev.2004.09.005 PubMedCrossRef

28.

Mukherjee AN, Watts P, Al-Madfai H et al (2006) Impact of retinopathy of prematurity screening examination on cardiorespiratory indices: a comparison of indirect ophthalmoscopy and retcam imaging. Ophthalmology 113(9):1547–1552. doi:10.1016/j.ophtha.2006.03.056 PubMedCrossRef

29.

Shah PK, Narendran V, Saravanan VR et al (2006) Screening for retinopathy of prematurity–a comparison between binocular indirect ophthalmoscopy and RetCam 120. Indian J Ophthalmol 54(1):35–38PubMedCrossRef

30.

Strode SW, Gustke S, Allen A (1999) Technical and clinical progress in telemedicine. JAMA 281(12):1066–1068. doi:10.1001/jama.281.12.1066 PubMedCrossRef

31.

Wu C, Petersen RA, VanderVeen DK (2006) RetCam imaging for retinopathy of prematurity screening. J AAPOS 10(2):107–111. doi:10.1016/j.jaapos.2005.11.019 PubMedCrossRef

32.

The Committee for the Classification of Retinopathy of Prematurity (1984) An international classification of retinopathy of prematurity. Arch Ophthalmol 102(8):1130–1134

33.

Sickles EA (1991) Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology 179(2):463–468PubMed

34.

Varas X, Leborgne F, Leborgne JH (1992) Nonpalpable, probably benign lesions: role of follow-up mammography. Radiology 184(2):409–414PubMed

35.

Vizcaino I, Gadea L, Andreo L et al (2001) Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology 219(2):475–483PubMed

36.

Mant D, Fowler G (1990) Mass screening: theory and ethics. BMJ 300(6729):916–918PubMed

37.

Akobeng AK (2007) Understanding diagnostic tests 1: sensitivity, specificity and predictive values. Acta Paediatr 96(3):338–341. doi:10.1111/j.1651–2227.2006.00180.x PubMedCrossRef

38.

Sommer C, Gouillard C, Brugniart C et al (2003) Retinopathy of prematurity screening and follow-up with Retcam120: expertise of a team of neonatologists concerning 145 patients. Arch Pediatr 10(8):694–699. doi:10.1016/S0929–693X(03)00295–1 PubMedCrossRef

39.

Chiang MF, Wang L, Busuioc M et al (2007) Telemedical retinopathy of prematurity diagnosis: accuracy, reliability, and image quality. Arch Ophthalmol 125(11):1531–1538. doi:10.1001/archopht.125.11.1531 PubMedCrossRef

40.

Ells AL, Holmes JM, Astle WF et al (2003) Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study. Ophthalmology 110(11):2113–2117. doi:10.1016/S0161–6420(03)00831–5 PubMedCrossRef

41.

Balasubramanian M, Capone A Jr, Hartnett ME et al (2006) The Photographic Screening for Retinopathy of Prematurity Study (Photo-ROP): study design and baseline characteristics of enrolled patients. Retina 26(7):S4–S10, (Suppl)PubMed

42.

The Photographic Screening for Retinopathy of Prematurity Study (PHOTO-ROP) (2008) Primary outcomes. Retina 28:S47–S54CrossRef

43.

Capone A Jr (2007) Antiangiogenic therapy for aggressive posterior ROP (BLOCK-ROP study). American Academy of Ophthalmology Retina Subspecialty Day, New Orleans

44.

Frankenburg W (1975) Criteria in screening test selection. In: Frankenburg W (ed) Pediatric screening tests. Charles C. Thomas, Springfield, IL

45.

Moyer V, Elliott E (2001) How to practice evidence-based pediatrics. West J Med 174(3):158–159. doi:10.1136/ewjm.174.3.158 PubMedCrossRef

46.

Castillo-Riquelme MC, Lord J, Moseley MJ et al (2004) Cost-effectiveness of digital photographic screening for retinopathy of prematurity in the United Kingdom. Int J Technol Assess Health Care 20(2):201–213. doi:10.1017/S0266462304000984 PubMedCrossRef

47.

Yang MB (2007) Retinopathy of prematurity in infants with birth weight >or = 1250 grams-incidence, severity, and screening guideline cost-analysis. J AAPOS 11(2):208–210, author reply 210. doi:10.1016/j.jaapos.2006.07.006 PubMed

48.

Trese MT (2008) What is the real gold standard for ROP screening? Retina 28(3):S1–S2 SupplementPubMed

49.

Vinekar A, Trese MT, Capone A Jr (2008) Evolution of retinal detachment in posterior retinopathy of prematurity: impact on treatment approach. Am J Ophthalmol 145(3):548–555. doi:10.1016/j.ajo.2007.10.027 PubMedCrossRef

50.

Belmont JM, Mattioli LF, Goertz KK et al (1995) Evaluation of remote stethoscopy for pediatric telecardiology. Telemed J 1(2):133–149PubMed

51.

Finley JP, Warren AE, Sharratt GP, Amit M (2006) Assessing children’s heart sounds at a distance with digital recordings. Pediatrics 118(6):2322–2325. doi:10.1542/peds.2006–1557 PubMedCrossRef

52.

Sable C (2003) Telemedicine applications in pediatric cardiology. Minerva Pediatr 55(1):1–13PubMed

53.

Early Treatment Diabetic Retinopathy Study Research Group (1991) Grading diabetic retinopathy from stereoscopic color fundus photographs–an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology 98(5 Suppl):786–806

54.

Cheung JC, Dick PT, Kraft SP et al (2000) Strabismus examination by telemedicine. Ophthalmology 107(11):1999–2005. doi:10.1016/S0161–6420(00)00377–8 PubMedCrossRef

55.

Dawson E, Kennedy C, Bentley C et al (2002) The role of telemedicine in the assessment of strabismus. J Telemed Telecare 8(1):52–55. doi:10.1258/1357633021937361 PubMedCrossRef

56.

Fransen SR, Leonard-Martin TC, Feuer WJ, Hildebrand PL (2002) Clinical evaluation of patients with diabetic retinopathy: accuracy of the Inoveon diabetic retinopathy-3DT system. Ophthalmology 109(3):595–601. doi:10.1016/S0161–6420(01)00990–3 PubMedCrossRef

Title: Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 18-month experience with telemedicine screening
Authors: Ruwan A. Silva
Yohko Murakami
Atul Jain
Jarel Gandhi
Eleonora M. Lad
Darius M. Moshfeghi
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 1/2009
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-008-0943-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 18-month experience with telemedicine screening

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Design

Participants

Methods

Main outcome measures

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2009

Evolution of lamellar macular hole studied by optical coherence tomography

Selecting highly sensitive non-obese diabetic mice for improving the study of Sjögren’s syndrome

Upregulation of Semaphorin 3A and the associated biochemical and cellular events in a rat model of retinal detachment

Deposit of glass fragments during femtosecond laser penetrating keratoplasty

Lutein prevents cataract development and progression in diabetic rats

Repeatability intraexaminer and agreement in amplitude of accommodation measurements