Multimodal Imaging, Tele-Education, and Telemedicine in Retinopathy of Prematurity

Abstract

Retinopathy of prematurity (ROP) is a disease that affects retinal vasculature in premature infants and remains one of the leading causes of blindness in childhood worldwide. ROP screening can encounter some difficulties such as the lack of specialists and services in rural areas. The evolution of technology has helped address these issues and led to the emergence of state-of-the-art multimodal digital imaging devices such fundus cameras with its variable properties, optical coherence tomography (OCT), OCT angiography, and fluorescein angiography which has helped immensely in the process of improving ROP care and understanding the disease pathophysiology. Computer-based imaging analysis and deep learning have recently been demonstrating promising outcomes in regard to ROP diagnosis. Telemedicine is considered an acceptable alternative to clinical examination when optimal circumstances for ROP screening in certain areas are lacking, and the expansion of these programs has been reported. Tele-education programs in ROP have the potential to improve the quality of training to physicians to optimize ROP care.

Keywords: Imaging; retinopathy of prematurity; tele-education; telemedicine.

Figure 1

Montage FA demonstrating leakage from extraretinal neovascularization in stage 3 ROP. FA: Fluorescein angiography, ROP: Retinopathy of prematurity

Figure 2

A montage FA showing peripheral vascular arrest with no abnormal vascular network and no leakage. FA: Fluorescein angiography

Figure 3

(a) A preoperative left eye fundus photo with peripheral laser marks, contracting peripapillary tractional retinal detachment, epiretinal fibrosis at the macula, and overlying localized vitreous hemorrhage. (b) SDOCT capturing the area of traction. (c) A postoperative fundus image and SDOCT (d) after releasing the traction and removing fibrous tissues. SDOCT: Spectral-domain optical coherence tomography

Figure 4

(a) Fundus photo showing peripapillary retinal detachment, traction along the vascular arcades, and attached peripheral retina. (b) SDOCT shows dragged macula towards the optic disc with disrupted foveal depression. (c) Fundus photo 1-month postmembrane peeling, and dissection shows residual traction along the vascular arcades and over the disc, the macula is flat. (d) The foveal structure regained its normal contour after surgical Intervention. SDOCT: Spectral-domain optical coherence tomography