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A.L. Ells, PHOTOROP Study Group; Telemedicine Screening for Clinically Significant Retinopathy of Prematurity: A Multicenter Clinical Trial . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3491.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the utility of remotely interpreted digital retinal images for longitudinal screening for referral–warranted retinopathy of prematurity (clinically significant retinopathy of prematurity – CSROP). Methods: In this prospective, longitudinal, multicenter cohort comparative study, all infants were examined longitudinally employing both indirect ophthalmoscopy (current standard) and digital photography using the RetCam–120 Digital Retinal Camera (Massie Research Laboratories Inc., Dublin, CA). Images were transferred via the Internet for remote interpretation by masked readers. CSROP was defined as any ROP in zone 1, any stage 3 ROP, two or more quadrants of plus disease or worse at the optic disc, or two or more quadrants of peripheral plus disease. Results: Fifty–one consecutive premature infants at risk for ROP were followed for a total of 330 exam–weeks. CSROP was diagnosed in 78 (77%) eyes by indirect ophthalmoscopy during serial examination. Digital imaging had a sensitivity of 100% in detecting CSROP, and 95% sensitivity in detecting ROP at treatment threshold per the Early Treatment for ROP (ETROP) Study. Overall, CSROP was diagnosed 1.5 weeks before ROP severe enough to require treatment (p < 0.0002). In 95% of eyes, CSROP was diagnosed by digital photography before or at the same time as by indirect ophthalmoscopy. Use of digital screening to limit bedside exams until CSROP is noted would have reduced the number of bedside exams by 104 weekly exams (104/330, 31.5%), or an average 2.1 weekly exams per eye. Conclusions: Serial digital imaging using the RetCam–120 system has excellent sensitivity in detecting CSROP. The definition of CSROP employed in this study effectively identified eyes requiring close scrutiny, with ample lead–time prior to the need for laser treatment. Children at–risk for ROP can be safely pre–screened at remote sites with telemedicine strategies, significantly reducing the number of bedside examinations per child.
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