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.
Keywords Retinopathy of prematurity - ROP - Telemedicine - Retrospective study
Financial Disclosure: DMM serves on the Scientific Advisory Board for Clarity Medical Systems (Pleasanton, CA, USA), the manufacturer
of the RetCam, RetCam II, and Shuttle cameras.