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Observational Study
. 2019 Jun;67(6):840-845.
doi: 10.4103/ijo.IJO_1177_18.

Smartphone guided wide-field imaging for retinopathy of prematurity in neonatal intensive care unit - a Smart ROP (SROP) initiative

Anubhav Goyal  1 , Mahesh Gopalakrishnan  1 , Giridhar Anantharaman  1 , Dhileesh P Chandrashekharan  1 , Thomas Thachil  1 , Ashish Sharma  2
Affiliations
Observational Study

Smartphone guided wide-field imaging for retinopathy of prematurity in neonatal intensive care unit - a Smart ROP (SROP) initiative

Anubhav Goyal et al. Indian J Ophthalmol. 2019 Jun.

Abstract

Purpose: To suggest a low cost, non-contact smartphone-based screening system in retinopathy of prematurity (ROP), and to illustrate its potential clinical application as a potential future tool for teleophthalmology.

Methods: Neonatal intensive care unit (NICU)-based bedside ROP screening done between January 2018 and May 2018. Documentation of ROP was done by using a smartphone and +40D, +28D, or +20D indirect non-contact condensing lenses. By using the coaxial light source of the phone, this system works as an indirect ophthalmoscope that creates a digital image of the fundus. With smartphone-based camera we extracted high-quality still images extracted from the video clip.

Results: Total of 228 eyes of 114 infants screened for ROP between January 2018 and May 2018. Incidence of total ROP was 23.68%, out of which incidence of type 1 ROP was 8.77%. After initial screening with indirect ophthalmoscope, we uesd smartphone imaging to document ROP in 28 eyes out of 55 eyes having ROP. Image quality was good in 89.28% eyes. Field of view vary from 46°, 53°, and 90° with +20D, +28D, and +40D indirect condensing lenses, respectively, which gives excellent images for bedside ROP documentation.

Conclusion: The described technique of smartphone fundus photography is a light weight, cost-effective, user friendly, high-quality wide-field fundus photographs for bedside documentation of ROP in NICUs using readily available instruments that are handy and portable with simple power sources. Smartphones has the potential to be operated with only one hand. It can also be used as a future telescreening device.

Keywords: Condensing lens-Smartphone-MIIRetCam (CSM) device assembly; neonatal intensive care unit; retinopathy of prematurity.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Technique of Smart retinopathy of prematurity (ROP) and field of view from different condensing lenses – (a) showing technique to hold condensing lens-smartphone-MIIRetCam (CSM) device assembly while ROP screening, (b) shows field of view of 30° from +20D lens, (c) field of view of 55° from +28D lens, (d) field of view of 90° from +40D lens, (e) showing technique to rotate the globe with pediatric wire vectis to visualize retinal periphery
Figure 2
Figure 2
Make It Yourself (MIY) assembly and technique of Smart retinopathy of prematurity (ROP) and field of view through 40D condensing lenses – (a) showing MIY device assembly, (b) technique to hold condensing lens-smartphone-black tube (MIY) assembly while ROP screening, (c) shows field of view from +40D lens, (d) stage 3 ridge and avascular retina, (e) plus disease with dilated and tortuous vessels, (f) fresh laser marks, (g) scars marks after laser treatment
Figure 3
Figure 3
Various retinopathy of prematurity (ROP) presentations – (a) glare due to mid-dilated pupil, (b) wide-field view of a normal retina, (c) plus disease with ridge (arrow) in zone 1, (d) laser marks (arrow), (e) aggressive posterior ROP in zone 1, (f) demarcation between vascular and avascular retina (arrow), (g) ridge (arrow) in zone 2, (h) stage 3 fibrovascular proliferation in zone 2 (arrow), (i) dilated tortuous vessels in all four quadrants s/o plus disease, (j) laser scar marks in periphery, (k) skip area between normal retina and laser marks (arrow), (l) ora serrata nicely seen with scleral depression
Figure 4
Figure 4
(A) Case of zone 1 retinopathy of prematurity (ROP) showing (a) plus disease with ridge (arrow) in the right eye, (b) zone 1 with ridge (arrow) in the left eye, (c) complete resolution of plus disease and ridge after anti-vascular endothelial growth (VEGF) injection in the left eye, (d) recurrence of ridge (arrow) after 4 weeks of anti-VEGF injection, (e) shows rescue laser treatment marks (arrow) anterior to ridge in the left eye. (B) Case of aggressive posterior ROP (APROP) showing (a) plus disease in zone 1, (b) demarcation between vascular and avascular retina (arrowheads) at zone 1 edge, (c) laser marks, (d) complete regression of plus disease, (e) laser scar marks (arrow) in retinal periphery
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References

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