Real-World Simulation of an Alternative Retinopathy of Prematurity Screening System in Thailand: A Pilot Study

• Type of Material: Article
• Authors: S. Grace Prakalapakorn, Duke University; Sharon F. Freedman, Duke University; Amy Hutchinson, Emory University; Piyada Saehout, Chulalongkorn University; Mine Cetinkaya-Rundel, Duke University; David K. Wallace, Duke University; Kittisak Kulvichit, Chulalongkorn University
• Language: English
• Date: 2018-07-01
• Publisher: Slack
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Healio.
• Final Published Version (URL): http://dx.doi.org/10.3928/01913913-20180327-04
• Title of Journal or Parent Work: Journal of Pediatric Ophthalmology and Strabismus
• ISSN: 0191-3913
• Volume: 55
• Issue: 4
• Start Page: 245
• End Page: 253
• Grant/Funding Information: Dr. Prakalapakorn is supported by NIH K23EY024268.; This project was partially funded by an unrestricted grant from Research to Prevent Blindness to the Duke Eye Center.
• Keywords: Science & Technology; Ophthalmology; Pediatrics; TELE-MEDICINE; INDIA; Life Sciences & Biomedicine; TELEMEDICINE
• Research Categories: Health Sciences, Opthamology

Abstract

Purpose: To evaluate an alternative retinopathy of prematurity (ROP) screening system that identifies infants meriting examination by an ophthalmologist in a middleincome country. Methods: The authors hypothesized that grading posterior pole images for the presence of pre-plus or plus disease has high sensitivity to identify infants with type 1 ROP that requires treatment. Part 1 of the study evaluated the feasibility of having a non-ophthalmologist health care worker obtain retinal images of prematurely born infants using a non-contact retinal camera (Pictor; Volk Optical, Inc., Mentor, OH) that were of sufficient quality to grade for pre-plus or plus disease. Part 2 investigated the accuracy of grading these images to identify infants with type 1 ROP. The authors prospectively recruited infants at Chulalongkorn University Hospital (Bangkok, Thailand). On days infants underwent routine ROP screening, a trained health care worker imaged their retinas with Pictor. Two ROP experts graded these serial images from a remote location for image gradability and posterior pole disease. Results: Fifty-six infants were included. Overall, 69.4% of infant imaging sessions were gradable. Among gradable images, the sensitivity of both graders for identifying an infant with type 1 ROP by grading for the presence of pre-plus or plus disease was 1.0 (95% confidence interval [CI]: 0.31 to 1.0) for grader 1 and 1.0 (95% CI: 0.40 to 1.0) for grader 2. The specificity was 0.93 (95% CI: 0.76 to 0.99) for grader 1 and 0.74 (95% CI: 0.53 to 0.88) for grader 2. Conclusions: It was feasible for a trained non-ophthalmologist health care worker to obtain retinal images of infants using the Pictor that were of sufficient quality to identify infants with type 1 ROP.