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A. Lajoie, S. Koreen, L. Wang, S. A. Kane, T. C. Lee, D. J. Weissgold, A. M. Berrocal, J. T. Flynn, J. B. Starren, M. F. Chiang; Retinopathy of Prematurity Management Using Single-Image vs. Multiple-Image Telemedicine Examinations. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1389.
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To compare performance of single-image versus multiple-image telemedicine examinations for diagnosis of retinopathy of prematurity (ROP).
248 eyes from 67 consecutive infants underwent wide-angle retinal imaging by a trained neonatal nurse at 31-33 weeks and/or 35-37 weeks post-menstrual age (PMA) at a single academic institution. Data were uploaded to a web-based telemedicine system and interpreted by three masked retinal specialists. Diagnoses were provided based on single-images, and subsequently on multiple-images, from both eyes of each infant. Findings were compared to a reference standard of indirect ophthalmoscopy by a pediatric ophthalmologist. Primary outcome measures were recommended follow-up interval, presence of plus disease, presence of type-2 prethreshold or worse ROP, and presence of visible peripheral ROP.
Among the three graders, mean sensitivity/specificity for detection of infants requiring follow-up in <1 week were 0.85/0.93 by single-image examination, and 0.91/0.88 by multiple-image examination at 35-37 weeks PMA. Mean sensitivity/specificity for detection of infants with type-2 or worse ROP were 0.82/0.95 by single-image examination, and 1.00/0.87 by multiple-image examination at 35-37 weeks PMA. Mean sensitivity/specificity for detection of plus disease were 1.00/0.86 by single-image examination, and 1.00/0.87 by multiple-image examination at 35-37 weeks PMA. There were no statistically-significant intra-grader differences between single-image and multiple-image telemedicine examinations for detection of plus disease or type-2 or worse ROP.
Single-image telemedicine exam performs comparably to multiple-image examination for detection of clinically-significant ROP. This may have implications for development of screening protocols, particularly in areas with limited access to ophthalmic care.
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