Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study

Ophthalmology. 2003 Nov;110(11):2113-7. doi: 10.1016/S0161-6420(03)00831-5.


Purpose: To evaluate the use of remote reading of digital retinal photographs in the diagnosis of severe (referral-warranted) retinopathy of prematurity (ROP) during longitudinal screening for ROP.

Study design: Prospective, longitudinal cohort study.

Subjects: Forty-four consecutive premature infants at risk for ROP.

Methods: All infants were examined longitudinally, over a series of examinations, by indirect ophthalmoscopy (gold standard) and digital photography using the RetCam-120 Digital Retinal Camera (Massie Research Laboratories Inc., Dublin, CA) equipped with an ROP lens. Images were stored and read remotely by a masked reader. Referral-warranted ROP was defined as ROP in zone 1, the presence of plus disease or the presence of any stage 3 ROP. We determined whether and when referral-warranted ROP was diagnosed for each eye, of each infant, on each examination, during the course of each of the infant's screening.

Results: Severe (referral-warranted) ROP was diagnosed in 23 eyes by indirect ophthalmoscopy during their series of examinations. Digital photography had a sensitivity of 100% and a specificity of 96% in detecting referral-warranted ROP. The positive predictive value of digital photography was 92%, and the negative predictive value was 100%. In 87% of eyes, referral-warranted ROP was diagnosed by digital photography before or at the same time as indirect ophthalmoscopy.

Conclusions: Longitudinal remote reading of digital photographs using the RetCam-120 system has excellent specificity and sensitivity in detecting referral-warranted ROP. This pilot study has shown that remote reading of digital photographs has promise for telemedicine strategies in ROP screening.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cohort Studies
  • False Positive Reactions
  • Feasibility Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Infant
  • Infant, Newborn
  • Ophthalmoscopy
  • Photography / methods*
  • Pilot Projects
  • Predictive Value of Tests
  • Prospective Studies
  • Remote Consultation / methods*
  • Reproducibility of Results
  • Retinopathy of Prematurity / diagnosis*
  • Sensitivity and Specificity