Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity

e-ROP Cooperative Group

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

IMPORTANCE: The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy.

OBJECTIVE: To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist.

DESIGN, SETTING, AND PARTICIPANTS: An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013.

INTERVENTIONS: Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements.

MAIN OUTCOMES AND MEASURES: The validity of grading retinal image setswas based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination.

ESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2%of eyes (19.4%of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95%CI, 77.4-85.6) and specificity of 90.1% (95%CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0%(95%CI, 85.4-93.5), with specificity of 87.0% (95%CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5%at the observed RW-ROP rate of 19.4%.

CONCLUSIONS AND RELEVANCE: When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP.

Original languageEnglish (US)
Pages (from-to)1178-1184
Number of pages7
JournalJAMA Ophthalmology
Volume132
Issue number10
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

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Retinopathy of Prematurity
Telemedicine
Referral and Consultation
Birth Weight
Neonatal Intensive Care Units
Premature Infants
Gestational Age
Observational Studies
Reading
Physicians
Sensitivity and Specificity

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity. / e-ROP Cooperative Group.

In: JAMA Ophthalmology, Vol. 132, No. 10, 01.10.2014, p. 1178-1184.

Research output: Contribution to journalArticle

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title = "Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity",
abstract = "IMPORTANCE: The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10{\%} ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy.OBJECTIVE: To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist.DESIGN, SETTING, AND PARTICIPANTS: An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013.INTERVENTIONS: Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements.MAIN OUTCOMES AND MEASURES: The validity of grading retinal image setswas based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination.ESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2{\%}of eyes (19.4{\%}of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9{\%} (95{\%}CI, 77.4-85.6) and specificity of 90.1{\%} (95{\%}CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0{\%}(95{\%}CI, 85.4-93.5), with specificity of 87.0{\%} (95{\%}CI, 84.0-89.5), negative predictive value of 97.3{\%}, and positive predictive value of 62.5{\%}at the observed RW-ROP rate of 19.4{\%}.CONCLUSIONS AND RELEVANCE: When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP.",
author = "{e-ROP Cooperative Group} and Quinn, {Graham E.} and Ying, {Gui Shuang} and Ebenezer Daniel and Hildebrand, {P. Lloyd} and Anna Ells and Agnieshka Baumritter and Kemper, {Alex R.} and Schron, {Eleanor B.} and Kelly Wade and Duros, {Trang B.} and Lisa Erbring and Repka, {Michael X.} and Shepard, {Jennifer A.} and Pamela Donohue and David Emmert and Herring, {C. Mark} and Deborah VanderVeen and Suzanne Johnston and Carolyn Wu and Jason Mantagos and Danielle Ledoux and Tamar Winter and Frank Weng and Theresa Mansfield and Bremer, {Don L.} and Richard Golden and McGregor, {Mary Lou} and Jordan, {Catherine Olson} and Rogers, {David L.} and Fellows, {Rae R.} and Suzanne Brandt and Brenda Mann and Wallace, {David K.} and Sharon Freedman and Jones, {Sarah K.} and Du Tran-Viet and Young, {Rhonda Michelle} and Barr, {Charles C.} and Rahul Bhola and Craig Douglas and Peggy Fishman and Michelle Bottorff and Brandi Hubbuch and Rachel Keith and Bothun, {Erick D.} and Inge DeBecker and Jill Anderson and Holleschau, {Ann Marie} and Miller, {Nichole E.} and Nyquist, {Darla N.}",
year = "2014",
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T1 - Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity

AU - e-ROP Cooperative Group

AU - Quinn, Graham E.

AU - Ying, Gui Shuang

AU - Daniel, Ebenezer

AU - Hildebrand, P. Lloyd

AU - Ells, Anna

AU - Baumritter, Agnieshka

AU - Kemper, Alex R.

AU - Schron, Eleanor B.

AU - Wade, Kelly

AU - Duros, Trang B.

AU - Erbring, Lisa

AU - Repka, Michael X.

AU - Shepard, Jennifer A.

AU - Donohue, Pamela

AU - Emmert, David

AU - Herring, C. Mark

AU - VanderVeen, Deborah

AU - Johnston, Suzanne

AU - Wu, Carolyn

AU - Mantagos, Jason

AU - Ledoux, Danielle

AU - Winter, Tamar

AU - Weng, Frank

AU - Mansfield, Theresa

AU - Bremer, Don L.

AU - Golden, Richard

AU - McGregor, Mary Lou

AU - Jordan, Catherine Olson

AU - Rogers, David L.

AU - Fellows, Rae R.

AU - Brandt, Suzanne

AU - Mann, Brenda

AU - Wallace, David K.

AU - Freedman, Sharon

AU - Jones, Sarah K.

AU - Tran-Viet, Du

AU - Young, Rhonda Michelle

AU - Barr, Charles C.

AU - Bhola, Rahul

AU - Douglas, Craig

AU - Fishman, Peggy

AU - Bottorff, Michelle

AU - Hubbuch, Brandi

AU - Keith, Rachel

AU - Bothun, Erick D.

AU - DeBecker, Inge

AU - Anderson, Jill

AU - Holleschau, Ann Marie

AU - Miller, Nichole E.

AU - Nyquist, Darla N.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - IMPORTANCE: The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy.OBJECTIVE: To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist.DESIGN, SETTING, AND PARTICIPANTS: An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013.INTERVENTIONS: Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements.MAIN OUTCOMES AND MEASURES: The validity of grading retinal image setswas based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination.ESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2%of eyes (19.4%of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95%CI, 77.4-85.6) and specificity of 90.1% (95%CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0%(95%CI, 85.4-93.5), with specificity of 87.0% (95%CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5%at the observed RW-ROP rate of 19.4%.CONCLUSIONS AND RELEVANCE: When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP.

AB - IMPORTANCE: The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy.OBJECTIVE: To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist.DESIGN, SETTING, AND PARTICIPANTS: An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013.INTERVENTIONS: Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements.MAIN OUTCOMES AND MEASURES: The validity of grading retinal image setswas based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination.ESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2%of eyes (19.4%of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95%CI, 77.4-85.6) and specificity of 90.1% (95%CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0%(95%CI, 85.4-93.5), with specificity of 87.0% (95%CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5%at the observed RW-ROP rate of 19.4%.CONCLUSIONS AND RELEVANCE: When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP.

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