Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 18-month experience with telemedicine screening

Graefes Arch Clin Exp Ophthalmol. 2009 Jan;247(1):129-36. doi: 10.1007/s00417-008-0943-z. Epub 2008 Sep 11.


Purpose: To report the 18-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.

Design: Retrospective analysis of the SUNDROP archival data between 1 December 2005 and 30 May 2007, evaluating this new diagnostic technology for ROP screening.

Participants: All 97 consecutively enrolled infants in the SUNDROP network.

Methods: All patients were screened using the RetCam II, and evaluated by the SUNDROP reading center at Stanford University. Nurses were trained to obtain five images in each eye. All patients were screened by an ophthalmologist trained in diagnosing ROP within 1 week of discharge from the hospital.

Main outcome measures: Outcomes included referral-warranted disease, need for treatment, and anatomic outcomes. Referral-warranted disease was defined as any Early Treatment Retinopathy of Prematurity Disease Type 2 or greater, threshold disease, any plus disease, and any stage 4 or higher disease.

Results: In the initial 18-month period, the SUNDROP telemedicine screening initiative has not missed any referral-warranted disease for ROP. A total of 97 infants (194 eyes) were enrolled, resulting in 443 unique examinations and 4,929 unique images. The mean birth weight of the infants was 1,186.9 grams, with a mean gestational age at birth of 28.9 weeks. Seven infants were identified with referral-warranted disease; six patients underwent laser photocoagulation and completely regressed. The one remaining patient regressed spontaneously, and did not require intervention. Calculated sensitivity and specificity was 100% and 98.9% respectively. No patient progressed to retinal detachment or other adverse outcome. Inadequate exposure, artifact, poor visualization of the periphery, and lack of a complete standardized image set in some patients were identified as areas requiring further assessment.

Conclusions: The SUNDROP telemedicine screening initiative for ROP has proven to have a high degree of sensitivity and specificity for identification of referral-warranted disease. Training was easily implemented. All cases of referral-warranted disease were captured. There were no adverse outcomes.

Publication types

  • Validation Study

MeSH terms

  • Diagnostic Techniques, Ophthalmological / standards*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Neonatal Nursing / methods*
  • Neonatal Screening / methods
  • Neonatal Screening / standards*
  • Referral and Consultation
  • Retinopathy of Prematurity / diagnosis*
  • Retinopathy of Prematurity / nursing*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Telemedicine / standards*