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Telemedicine Screening for Retinopathy of Prematurity Among the enrolled infants, 19.4 % developed RW-ROP in one or both eyes on diagnostic examination. In the primary outcome report, 6 all images from the 244 infants who developed RW-ROP and a random sample of 691 infants who never developed RW-ROP were graded. The result of each diagnostic examination was compared with the result of the image set grading from the same session. The sensitivity for detecting the presence of RW-ROP in either eye of an infant, as would be performed in a clinical setting, was 90.0 % (95 % CI 85.4–93.5 %) with a specificity of 87 % (95 % CI 84.0–89.5 %) and a negative predictive value of 97.3 %. When only the last session before treatment was considered, sensitivity increased to 98.2 % (95 % CI 94.4– 99.4 %) for detecting those 162 infants who underwent treatment with a specificity of 80.2 % and a negative predictive value of 99.6 %. Only three infants who were treated by the clinical center ophthalmologist were not found to have RW-ROP in retinal images of either eye. In summary, the e-ROP study results provide strong support for the validity of a telemedicine system to detect the presence of potentially serious ROP. The study successfully trained nonphysician imagers at the clinical centers to obtain images for remote grading and nonphysicians readers to grade those images reliably. It provides further evidence that telemedicine in ROP is a promising approach to providing excellent ROP screening in the US and other countries with well-developed neonatal intensive care unit (NICU) systems. Since there is a limited supply of ophthalmologists available for ROP examinations, such an approach will allow physicians to examine only 1. Blencowe H, Lawn JE, Vazquez T, et al., Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010, Pediatr Res, 2013;74(Suppl. 1):35–49. 2. World Health Organization, Born too soon: the global action report on preterm birth, World Health Organization Press, 2012. Available at: news/2012/201204_borntoosoon-report.pdf (last accessed February 2, 2015). U S Oph th a l mic Review those most at-risk infants. One advantage of such a system is the ability to assess remotely the need for transferring an infant to another center where treatment can be given. In addition, the imaging session in a NICU need not be constrained by the ophthalmologist’s schedule, but can be conducted at an optimal time for the infant. In other regions of the world with developing NICU systems and a limited number of ophthalmologists available, providing a telemedicine system can increase the likelihood of detecting potentially serious ROP. This may be particularly important in countries with widely dispersed populations and a limited number of ophthalmologists. Still there are a number of matters that need to be addressed as we consider telemedicine in ROP. We must deal with licensing and liability concerns for telemedicine and establish reliable and consistent grading of the images. Timely reporting of these time-sensitive gradings to the physicians caring for the at-risk infant must be expedited. The cost-effectiveness of such a technology is yet to be established. In addition, the best schedule and optimal frequency for imaging of an individual infant needs to be developed and tailoring such a schedule will likely include various risk factors such as birth weight, gestational age, postmenstrual age, and weight gain. Further, thus far level 1 telemedicine ROP studies have only dealt with the period during which the infant is in the NICU and not addressed when a child can be safely discharged from care. n 3. Chiang MF, Melia M, Buffenn AN, et al., Detection of clinically significant retinopathy of prematurity using wide-angle digital retinal photography, Ophthalmology, 2012;119:1272–80. 4. Fierson WM, Capone A, The American Academy Of Pediatrics Section On Ophthalmology, American Academy Of Ophthalmology, And American Association Of Certified Orthoptists. Telemedicine for Evaluation of Retinopathy of Prematurity, Pediatrics, 2015;135:e238–54. 5. Quinn GE; e-ROP Cooperative Group, Telemedicine approaches to evaluating acute-phase retinopathy of prematurity: study design, Ophthalmic Epidemiol, 2014;21:256–67. 6. Quinn GE, Ying GS, Daniel E, et al., for the e-ROP Cooperative Group. Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity, JAMA Ophthalmol, 2014;132:1178–84. 7. Ells AL, Holmes JM, Astle WF, et al., Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study, Ophthalmology, 2003;110:2113–7. 67