ROP screening with the Pictor Plus camera: a telemedicine solution for developing countries

Abstract

Purpose: To assess the Pictor Plus portable noncontact ophthalmic camera for use in diagnosis of severe retinopathy of prematurity (ROP) and its feasibility for telemedicine applications, especially in developing countries.

Methods: A cross-sectional study was conducted from April 2018 to December 2019 in six public neonatal care centers in the state of Rio de Janeiro. Observer 1 performed the examination with a binocular indirect ophthalmoscope and subsequently captured a digital image using the Pictor Plus camera. These images were analyzed by observers 2 and 3, who were masked to the results recorded by observer 1.

Results: The convenience sample was 200 premature newborns (n = 712 eyes) with a birthweight of ≤1,500 g or gestational age at birth of ≤32 weeks. The sensitivity of Pictor Plus digital images for the diagnosis of plus or pre-plus disease was 65.8% for observer 2 and 63.2% for observer 3; the specificity, 100% and 98,4%, respectively. Interobserver agreement analysis for image reading compared to observer 1 indirect ophthalmoscopy showed kappa coefficients of 0.77 (observer 2) and 0.68 (observer 3).

Conclusions: In our study cohort, the Pictor Plus, a relatively low-cost camera, was effective in facilitating accurate diagnosis of ROP.