Department of Ophthalmology, Byers Eye Institute, Horngren Family Vitreoretinal Center, Palo Alto, CA 94303, USA.
Curr Eye Res. 2013 Feb;38(2):283-91. doi: 10.3109/02713683.2012.754902. Epub 2013 Jan 18.
To report the four-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative, which was developed to reduce the risk of blindness from retinopathy of prematurity (ROP).
A retrospective analysis of the SUNDROP archival data between 12/1/2005 and 11/30/2009. A total of 410 consecutively enrolled infants meeting ROP screening criteria had nurse-obtained fundoscopic images evaluated remotely by an ROP specialist. Every infant then received at least one dilated bedside binocular indirect ophthalmoscope (BIO) examination within one week of discharge. All infants were then followed with both telemedicine images and bedside evaluation in clinic according to recommended screening timelines. Primary outcomes were treatment-warranted ROP (TW-ROP), defined as Early Treatment of ROP Type 1, and adverse anatomical outcomes.
The SUNDROP telemedicine screening initiative has not missed any TW-ROP in its four-year evaluation period. A total of 410 infants (820 eyes) were imaged, resulting in 1486 examinations and 18,097 unique images. An average of 12.2 images were obtained per patient. Fourteen infants met TW-ROP criteria on telemedicine examination. After bedside evaluation, 13 infants required laser photocoagulation and one was followed until he spontaneously regressed. Infants with TW-ROP had a significantly lower gestational age (24.9 weeks), birth weight (658.7 grams), and were more likely to be male than the no TW-ROP cohort (all p values <0.00001). Telemedicine had a calculated sensitivity of 100%, specificity of 99.8%, positive predicative value of 92.9% and negative predictive value of 100% for the detection of TW-ROP. No patient progressed to retinal detachment or any adverse anatomical outcome.
The SUNDROP initiative demonstrated a high degree of diagnostic reliability and was able to capture all infants with TW-ROP. Telemedicine offers a cost-effective, reliable and accurate screening methodology for identifying infants with TW-ROP without sacrificing quality of care.
报告斯坦福大学早产儿视网膜病变诊断网络（SUNDROP）远程医疗计划的四年经验，该计划旨在降低早产儿视网膜病变（ROP）致盲的风险。
对 2005 年 12 月 1 日至 2009 年 11 月 30 日 SUNDROP 档案数据进行回顾性分析。共有 410 名符合 ROP 筛查标准的连续入组婴儿，由护士获得眼底图像，由 ROP 专家远程评估。每名婴儿出院后一周内至少接受一次散瞳双眼间接检眼镜（BIO）检查。所有婴儿随后根据推荐的筛查时间表，通过远程医疗图像和床边评估进行随访。主要结局是治疗性早产儿视网膜病变（TW-ROP），定义为早期治疗早产儿视网膜病变 1 型，以及不良解剖结局。
SUNDROP 远程医疗筛查计划在四年的评估期间没有错过任何 TW-ROP。共对 410 名婴儿（820 只眼）进行了成像，共进行了 1486 次检查和 18097 次独特图像。每名婴儿的平均图像数量为 12.2 张。通过远程医疗检查，有 14 名婴儿符合 TW-ROP 标准。床边评估后，13 名婴儿需要激光光凝治疗，1 名婴儿随访至自发消退。TW-ROP 婴儿的胎龄（24.9 周）、出生体重（658.7 克）明显低于无 TW-ROP 组（所有 P 值均<0.00001），且更可能为男性。远程医疗对 TW-ROP 的检测具有 100%的灵敏度、99.8%的特异性、92.9%的阳性预测值和 100%的阴性预测值。没有患者进展为视网膜脱离或任何不良解剖结局。
SUNDROP 计划证明了高度的诊断可靠性，能够捕捉所有 TW-ROP 婴儿。远程医疗提供了一种经济有效的、可靠和准确的筛查方法，用于识别有 TW-ROP 风险的婴儿，而不牺牲护理质量。
