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D. M. Moshfeghi; Stanford University Network for Diagnosis of Retinopathy of Prematurity: 1-Year Experience With Telemedicine Screening. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3114.
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To report the 1 year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.
Retrospective analysis of the SUNDROP archival data. Inclusive dates for this study were 12/1/05 through 11/30/2006. 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. 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 within one week of discharge from the neonatal intensive care unit.
In the initial 12-month period, the SUNDROP telemedicine screening initiative has not missed any referral warranted disease for ROP. A total of 42 infants have been imaged, resulting in 129 unique examinations and 1311 unique images. The average number of images per patient was 10.2 and the median was 10 (range of 2-21 images). Four infants were identified for referral-warranted disease; two patients underwent laser photocoagulation and regressed nicely. The two remaining patients are still being followed closely using the SUNDROP network. Additionally, 1 patient that was screened 1 time and then followed weekly in my outpatient clinic required treatment 3 weeks after discharge from the NICU. The calculated sensitivity was 100%, with specificity of 95% for detection of referral-warranted disease. No patient progressed to retinal detachment or other adverse anatomic 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. Technical difficulties included downloading of images, transferring to .jpeg format, and HIPAA-compliant transfer to the reading center.
The SUNDROP telemedicine screening initiative for retinopathy of prematurity has proven to have high degree of sensitivity (100%) and specificity (95%) 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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