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Graham E Quinn, Gui-Shuang Ying, Agnieshka Baumritter, Wei Pan, Ebenezer Daniel; Early detection of potentially severe ROP on remote image grading. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4736.
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Among the 447 eyes with referral-warranted (RW) ROP (stage 3 ROP, zone I ROP, plus disease) on diagnostic exam in the “Telemedicine approaches to evaluating acute-phase ROP (e-ROP)” study, image grading detected RW-ROP earlier than diagnostic exam in 191 (43%) eyes by about 15 days. We describe the characteristics of these eyes to provide insights into what types of ROP are most easily detected early by image assessment.
e-ROP images were graded remotely by trained non-physician readers using a standard protocol. We undertook a descriptive analysis of zone and stage of ROP and presence of plus disease in 191 eyes in which RW-ROP was noted on imaging before it was documented on clinical examination (Early) and compared them to 200 eyes with RW-ROP noted at the same time by imaging and clinical examination (Same). Demographic characteristics of these two groups of infants, including birth weight (BW), gestational age (GA), and postmenstrual age (PMA) at RW-ROP imaging session are compared.
BW and GA were similar for infants with Early or Same RW-ROP eyes (p>0.10). 60% of 191 Early eyes were noted to have RW-ROP findings on image grading by 34 weeks PMA, compared to 38% of 200 Same eyes (p<0.001). More than half of Early eyes showed positive RW-ROP clinical findings within 2 weeks. When comparing image grading with RW-ROP first found in exam results, Stage 3 ROP was noted in image evaluation in 79% (151/191) Early eyes and in 86% (172/200) Same eyes (p=0.08) and for the presence of zone I ROP in 30% (57/191) Early vs 32% (64/200) Same (p=0.64). For posterior pole vessels, 16% (30/191) of Early eyes and 23% (45/200) of Same eyes (p=0.09) were graded as plus disease on clinical exam. Majority of early eyes (>75%) was consistently called RW-ROP positive by imaging evaluation and agreed with exam finding in 87% of eyes when eye exam subsequently found RW-ROP.
In a majority of both Early and Same eyes, stage 3 was the factor that determined the designation for RW-ROP while zone I ROP accounted for a significant proportion and plus disease played a relatively minor factor in the RW-ROP determination. In the majority of Early RW-ROP eyes, the image findings were consistent and RW-ROP was later noted on the examination. As use of ROP telemedicine is used more widely, development of standard approaches and protocols are essential.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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