This prospective, multicenter study compared ophthalmoscopy with telemedicine for diagnosing retinopathy of prematurity (ROP).

Study design

Between 2011 and 2014, researchers enrolled 281 premature infants from 7 centers across the United States and Mexico. One eye of each newborn underwent indirect ophthalmoscopy and remote fundus image review by 3 telemedicine graders.

Both the ophthalmoscopy and telemedicine diagnoses were combined to establish a more accurate reference standard diagnosis (RSD). The results were compared with the RSD to determine the accuracy and sensitivity of each method.

Outcomes

No differences were found in overall diagnostic accuracy between the 2 modalities. Subgroup analyses revealed the diagnostic sensitivity of ophthalmoscopy and telemedicine were similar for detecting zone 1 (both 78%), plus disease (74% vs 79%, respectively) and type 2 (86% vs 79%, respectively) ROP. Ophthalmoscopy, however, was slightly more sensitive in identifying stage 3 disease (85% vs 73%; P=0.004).

Limitations

Both methods were limited by a significant intergrader variability.

Clinical significance

The authors believe the results support the use of telemedicine for the diagnosis of ROP. However, the intergrader variability suggests a need for consensus references instead of continuing to use ophthalmoscopy as the standard reference.