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Agnieshka Baumritter, Jaclyn Gurwin, Graham E Quinn, Gui-Shuang Ying, Lauren Tomlinson, Gil Binenbaum; Pilot Study of a Tiered Approach to ROP Screening (TARP) using a Weight Gain Predictive Model and a Telemedicine System. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6289.
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© ARVO (1962-2015); The Authors (2016-present)
The e-ROP Study telemedicine system of remote fundus image grading and the CHOP-ROP postnatal-weight-gain predictive model are two approaches for improving the efficiency of retinopathy of prematurity (ROP) screening. Since current screening has low specificity for severe ROP, we sought to develop a tiered approach for identifying children who develop severe ROP (TARP) by using these two modalities synergistically.
Secondary analysis of data on premature infants with birth weight (BW)<1251g from the e-ROP and G-ROP studies. Four approaches to ROP screening were evaluated: ROUTINE (only diagnostic examinations), MODEL (BW, gestational age-GA, weight gain calculated weekly initiates examinations when risk cut-point surpassed), IMAGING (trained-reader grading of type 1 or 2 ROP initiates examinations), and TARP (CHOP-ROP alarm initiates imaging, image finding of severe ROP initiates examinations).
The study included 242 infants, median BW 858g (range 690-1035). Sensitivity for type 1 ROP (32 (13%) infants) was 100% (95% CI 89.3%-100%) with all four approaches. With ROUTINE, 242 infants had 877 examinations. With MODEL, 184 infants had 730 examinations. With IMAGING, all 242 infants had 532 imaging sessions, with 94 having 345 examinations. With TARP, 182 infants had 412 imaging sessions with 87 having 322 examinations.
The MODEL alone decreased the number of infants requiring exams by 24% and exams by 17%. IMAGING required image acquisition and grading, but reduced infants receiving exams by 61% and exams by 60%. TARP decreased infants imaged by 25%, imaging sessions by 23%, infants examined by 63%, and exams by 63%. Applying a postnatal-growth model and telemedicine system in a tiered approach may improve ROP screening efficiency more than either approach alone. Further validation is needed before clinical use.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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