Imaging in Retinopathy of Prematurity

Abstract

Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness worldwide. Barriers to ROP screening and difficulties with subsequent evaluation and management include poor access to care, lack of physicians trained in ROP, and issues with objective documentation. Digital retinal imaging can help address these barriers and improve our knowledge of the pathophysiology of the disease. Advancements in technology have led to new, non-mydriatic and mydriatic cameras with wider fields of view as well as devices that can simultaneously incorporate fluorescein angiography, optical coherence tomography (OCT), and OCT angiography. Image analysis in ROP is also being employed through smartphones and computer-based software. Telemedicine programs in the United States and worldwide have utilized imaging to extend ROP screening to infants in remote areas and have shown that digital retinal imaging can be reliable, accurate, and cost-effective. In addition, tele-education programs are also using digital retinal images to increase the number of healthcare providers trained in ROP. Although indirect ophthalmoscopy is still an important skill for screening, digital retinal imaging holds promise for more widespread screening and management of ROP.

Keywords: imaging; retinopathy of prematurity; telemedicine.

FIGURE 1.

First human fundus photograph.

FIGURE 2.

Fundus photos (A to C) and fluorescein angiography (D to F) of a patient with retinopathy of prematurity who had previously been treated with laser. In the fluorescein angiography, signs of neovascularization and leakage are more obvious compared with the fundus photographs.

FIGURE 3.

Ultrawide-field optical coherence tomography of a patient undergoing routine retinopathy of prematurity screening.

FIGURE 4.

Optical coherence tomography angiography of a patient with an intact foveal avascular zone obtained during routine retinopathy of prematurity screening.