Original articleTelemedical Diagnosis of Retinopathy of Prematurity: Intraphysician Agreement between Ophthalmoscopic Examination and Image-Based Interpretation
Section snippets
Infrastructure for Telemedical Interpretation
This study was approved by the Institutional Review Board at Columbia University Medical Center. A neonatal intensive care unit (NICU) nurse was trained to perform wide-angle digital retinal imaging using a commercially available device (RetCam-II; Clarity Medical Systems, Pleasanton, CA). Training included 2-day initial instructional session with the device manufacturer, followed by 6 weekly sessions with the principal investigator (MFC) during regularly scheduled ophthalmoscopic examinations.
Study Population
The study included 67 consecutive infants whose parents consented to participate. This represented 62.0% of the 108 eligible infants hospitalized in the Columbia NICU who met inclusion criteria during the study period. Of the 41 (38.0%) eligible infants who did not participate, 32 (29.6%) parents could not be contacted by study personnel within the study period, 7 (6.5%) parents declined to provide informed consent, and 2 (1.9%) were considered unstable by their neonatologists for imaging.
Discussion
This study found that, first, intraphysician agreement between ophthalmoscopic examination and telemedical interpretation was very high. Second, neither ophthalmoscopy nor telemedicine methods had a systematic tendency to overdiagnose or underdiagnose ROP compared with the other method. Third, many clinically significant diagnostic discrepancies were based on uncertainty about presence of zone 1 or plus disease. By controlling for diagnostic variation among different physician graders, the
Acknowledgments
The authors thank Dr Zhiliang Ying for his statistical assistance with this study.
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2021, Expert Systems with ApplicationsCitation Excerpt :The wide-angle contact lens system uses two biconvex aspheric lenses and a two-element meniscus lens in combination with a cSLO-based platform to image up to 10 images of the retina (Kim, Lee, Park, Baek, & Lee, 2020), which is perceived as a valuable tool for the evaluation of retinopathy, and its use in combination with angiography is difficult to evaluate and manage through clinical or routine angiography. The fifth is RetCam, a contact-based system that can image the retina up to 130°, but limited by the illumination through the cornea, and any medium opacity will result in poor image quality, which is mainly used to image neonatal and pediatric patients in a range of conditions, including screening for retinopathy of prematurity (ROP) (Carolyn, Petersen, & VanderVeen, 2006; Scott et al., 2008) and the evaluation of retinal hemorrhage in cases of suspicious head trauma (Scott et al., 2008). The last is Panoret, which is currently not commercially available, and the retinal brightness due to illumination is extremely small to none (Kumar et al., 2021).
National Trends in the United States Eye Care Workforce from 1995 to 2017
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Manuscript no. 2007-613.
The authors have no commercial, proprietary, or financial interest in any of the products or companies described in the article.
Supported by a Career Development Award from Research to Prevent Blindness, New York, New York (MFC), and the National Eye Institute, Bethesda, Maryland (grant no. EY13972 [MFC]).