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Clinical Trial
. 2016 Jan;137(1):e20152256.
doi: 10.1542/peds.2015-2256. Epub 2015 Dec 15.

A Comparison of Strategies for Retinopathy of Prematurity Detection

Alex R Kemper  1 , Lisa A Prosser  2 , Kelly C Wade  3 , Michael X Repka  4 , Gui-shuang Ying  5 , Agnieshka Baumritter  6 , Graham E Quinn  6 ; e-ROP Study Cooperative Group
Collaborators, Affiliations
Clinical Trial

A Comparison of Strategies for Retinopathy of Prematurity Detection

Alex R Kemper et al. Pediatrics. 2016 Jan.

Abstract

Background and objectives: Delayed detection of type 1 retinopathy of prematurity (ROP) can lead to permanent visual impairment. Providing ROP examinations is challenging because of the limited ophthalmology workforce. This study compares digital imaging-based ROP detection strategies versus serial ROP examinations.

Methods: We conducted an individual-level microsimulation study of a hypothetical cohort of 650 infants with gestational age from 23 to 30 weeks. Infants were evaluated by using strategies based on indirect ophthalmoscopy or digital imaging beginning at 32 weeks' postmenstrual age (PMA) and continuing to discharge, transfer, or 40 weeks' PMA. ROP status and the accuracy of digital imaging were based on the e-ROP (Telemedicine Approaches to Evaluating Acute-Phase ROP) study, which enrolled high-risk infants.

Results: Within the hypothetical NICU, the strategy of ROP examinations identified an average of 45.8 cases of type 1 ROP by discharge, transfer, or 40 weeks' PMA, and another 1.9 cases were included in the group of infants recommended to have later follow-up. Digital imaging with an ROP examination at discharge identified all 47.7 cases of type 1 ROP. On average, the ROP examination-only strategy required 1745.7 ROP examinations, whereas digital imaging with a discharge examination required 1065.5 ROP examinations and 1786.2 digital imaging sessions.

Conclusions: Although digital imaging decreased the number of ROP examinations per infant, there was an increase in the total number of interventions (ie, ROP examinations and imaging sessions). Providing an ROP examination at the time of NICU discharge can significantly reduce the number of infants who require follow-up.

Trial registration: ClinicalTrials.gov NCT01264276.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Expected total cost of digital imaging with a discharge ROP examination for the hypothetical cohort of 650 infants across the range of estimates regarding costs of an ROP examination (initial/subsequent) and digital imaging.
FIGURE 2
FIGURE 2
Average expected outcomes across the simulations per infant according to GA, including the number or ROP examinations, the number of digital imaging sessions, and the likelihood of identifying type 1 ROP or of needing follow-up after discharge, transfer, or 40 weeks’ PMA.
See this image and copyright information in PMC

Comment in

References

    1. Blencowe H, Lawn JE, Vazquez T, Fielder A, Gilbert C. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res. 2013;74(suppl 1):35–49 - PMC - PubMed
    1. Javitt J, Dei Cas R, Chiang YP. Cost-effectiveness of screening and cryotherapy for threshold retinopathy of prematurity. Pediatrics. 1993;91(5):859–866 - PubMed
    1. Fierson WM; American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists . Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2013;131(1):189–195 - PubMed
    1. Kemper AR, Freedman SF, Wallace DK. Retinopathy of prematurity care: patterns of care and workforce analysis. J AAPOS. 2008;12(4):344–348 - PMC - PubMed
    1. Fijalkowski N, Zheng LL, Henderson MT, Wallenstein MB, Leng T, Moshfeghi DM. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): four-years of screening with telemedicine. Curr Eye Res. 2013;38(2):283–291 - PubMed

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