Telemedicine screening for retinopathy of prematurity (ROP) using digital retinal images: A pilot study.

Abstract

Purpose : To implement a neonatal ophthalmological screening program through the fundus evaluation with photographs acquired with a wide field camera for its interpretation through a reading center.

Methods : Prospective, longitudinal cohort study. The infants were examined over a series of examinations, by indirect ophthalmoscopy and digital photography using the 3nethra neo cam (Forus Health): a compact, portable, and easy-to-use mydriatic wide-field digital imaging system. Images were stored with an electronic file in which the sociodemographic and clinical data and the complete ophthalmological examination of the newborn were included. Maternal and newborn conditions considered as a risk factor for the development of retinopathy of prematurity were also recorded. All information was sent over the internet and the images were read by readers trained in retinopathy of prematurity. Referral-warranted ROP was defined as ROP in zone 1, the presence of plus disease or the presence of any Stage 3 ROP.

Results : 152 eyes corresponding to 76 newborns were included. 61.8% of the patients were males, the mean gestational age and postmenstrual age was 31.93 ± 2.50 and 36.63 ± 3.23 weeks respectively, the median birth weight was 1425 g (IQR: 1160-1800); low weight was present in 53.9% of newborns.
The incidence of ROP was 27.63% (21/76). In both eyes, the most frequently reported stage was stage 1; in the left eye, the highest reported stage was 4A, while for the right eye it was 4B corresponding to the same patient.
Of the total number of eyes with ROP 20% (N=40) presented Type 1 retinopathy of prematurity (ROP) and therefore required treatment.
It was observed that in the studied population birth weight, blood transfusion and days of hospital stay showed association with retinopathy of prematurity, in these 3 cases the p value was <0.05.

Conclusions : Our study demonstrates the utility of telemedicine for the detection of ROP in a developing country.
Screening through telemedicine is a tool capable of detecting those ROP cases that require treatment with additional utilities such as the study of risk factors related to the disease and the organization of data for epidemiological purposes.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.