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R. A. Silva, Y. Murakami, A. Jain, D. M. Moshfeghi; Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 36-Month Experience With Telemedicine Screening. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3142.
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© ARVO (1962-2015); The Authors (2016-present)
To report the 36-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.
Prospective analysis of the SUNDROP archival data. Inclusive dates for this study were 12/1/05 through 11/30/08. All patients screened at least one time using the RetCam II and evaluated by the SUNDROP reading center at Stanford University were included. Nurses were trained to obtain 5 images in each eye. The goal was to obtain 10 total images per patient at each exam. 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 or any plus disease. All patients were screened by the author (DMM) within one week of discharge from the neonatal intensive care unit.
In the initial 36-month period, the SUNDROP telemedicine screening initiative has not missed any referral- warranted ROP. A total of 261 infants (522 eyes) have been imaged, resulting in 1059 unique examinations and 12606 unique images. The average number of images per exam was 11.9 and the median was 12 (range of 2-40 images). Eight infants were identified with referral-warranted disease; six patients underwent laser photocoagulation and completely regressed. The two remaining patients regressed spontaneously, and did not require intervention. The calculated sensitivity was 100%, with specificity of 99.2% for detection of referral-warranted disease. No patient progressed to retinal detachment or other adverse anatomic outcomes. 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. Technical difficulties included downloading of images, transferring to .jpg format, and HIPAA-compliant transfer to the reading center.
The SUNDROP telemedicine initiative for retinopathy of prematurity has proven to have high degree of sensitivity (100%) and specificity (99.2%) for identification of referral-warranted disease. Training was easily implemented. All cases of referral-warranted disease were captured. There were no adverse anatomic outcomes.
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