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Author Notes:

Corresponding Author: S. Grace Prakalapakorn, MD, MPH, Duke University, Department of Ophthalmology, 2351 Erwin Rd; DUMC 3802, Durham, NC, USA 27710, Telephone: 919-684-3764 / Fax: 919-684-6096, grace.prakalapakorn@duke.edu.

Co-corresponding Author: Kittisak Kulvichit, MD, MSc, Chulalongkorn University, Department of Ophthalmology, 1873 Rama 4 Road; Pathumwan, Bangkok 10330, Thailand, Telephone: +662-256-4142, Fax: +662-256-4209, kulvichit@gmail.com.

Drs. Freedman and Wallace have developed a technology (ROPtool) which is not being used in this study, but ROPtool has been purchased by FocusROP (which is being used in this study).

The developers and Duke University may benefit financially from sales of FocusROP.

The funding organizations had no role in the design or conduct of this research or the decision to submit this report for publication.


Research Funding:

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.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Ophthalmology
  • Pediatrics

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


Journal Title:

Journal of Pediatric Ophthalmology and Strabismus


Volume 55, Number 4


, Pages 245-253

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2018 Healio.

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