SUNDROP: six years of screening for retinopathy of prematurity with telemedicine

Can J Ophthalmol. 2015 Apr;50(2):101-6. doi: 10.1016/j.jcjo.2014.11.005.


Objective: To report the 6-year results of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) initiative in the context of telemedicine screening initiatives for retinopathy of prematurity (ROP).

Design: A retrospective analysis.

Participants: Premature newborns requiring ROP screening at 6 neonatal intensive care units from December 1, 2005, to November 30, 2011.

Methods: Infants were evaluated via remote retinal photography by an ROP specialist. A total of 608 preterm infants meeting ROP examination criteria were screened with the RetCam II/III (Clarity Medical Systems, Pleasanton, Calif.). Primary outcomes were treatment-warranted ROP (TW-ROP) and adverse anatomical events.

Results: During the 6 years, 1216 total eyes were screened during 2169 examinations, generating 26 970 retinal images, an average of 3.56 examinations and 44.28 images per patient. Twenty-two (3.6%) of the infants screened met criteria for TW-ROP. Compared with bedside binocular ophthalmoscopy, remote interpretation of RetCam II/III images had a sensitivity of 100%, specificity of 99.8%, positive predicative value of 95.5%, and negative predicative value of 100% for the detection of TW-ROP. No adverse anatomical outcomes were observed for any enrolled patient.

Conclusions: The 6-year results for the SUNDROP telemedicine initiative were highly favourable with respect to diagnostic accuracy. Telemedicine appears to be a safe, reliable, and cost-effective complement to the efforts of ROP specialists, capable of increasing patient access to screening and focusing the resources of the current ophthalmic community on infants with potentially vision-threatening disease.

MeSH terms

  • Diagnosis, Computer-Assisted / methods*
  • False Negative Reactions
  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intensive Care Units, Neonatal
  • Male
  • Neonatal Screening / methods*
  • Ophthalmoscopy / methods
  • Photography / methods
  • Predictive Value of Tests
  • Retinopathy of Prematurity / diagnosis*
  • Retrospective Studies
  • Sensitivity and Specificity
  • Telemedicine / methods*
  • Vision Screening / instrumentation*