Ophthalmic Epidemiol. 2014 Aug;21(4):256-67. doi: 10.3109/09286586.2014.926940. Epub 2014 Jun 23.
Detecting sight-threatening retinopathy of prematurity (ROP) relies on a diagnostic examination (DE) performed by an experienced ophthalmologist. An alternative may be a telemedicine system where retinal images of at-risk infants are graded by readers to determine features of ROP indicating the need for a DE.
The multicenter Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) Study is a cohort study of 2000 infants with birth weights <1251 g. At each visit, ophthalmologists perform DEs and non-physician imagers obtain iris and five retinal images with the disc positioned in the center, right, left, up and down. Images are uploaded to a secure server for grading by non-physician readers for the detection of plus disease, stage 3 ROP and/or zone I disease, any of which indicates "referral-warranted ROP" (RW-ROP). Images from all infants with RW-ROP and a random sample of infants without RW-ROP (based on DEs) are selected for grading. Gradings are compared to DEs to determine the validity and evaluate reliability, feasibility, safety, and cost-effectiveness of the telemedicine system.
e-ROP is conducted in 12 Clinical Centers in the US and Canada with Study Headquarters, the Data Coordinating Center and the Image Reading Center in Philadelphia and the ROP Data Center in Oklahoma City. A total of 27 study center coordinators, 34 ophthalmologists, 26 imagers, and 4 readers have been certified. All study data are submitted using a secure web-based system.
The design and findings of this study will be useful to conduct other ROP studies or evaluate telemedicine for other diseases.
检测具有视力威胁的早产儿视网膜病变（ROP）依赖于由经验丰富的眼科医生进行的诊断检查（DE）。另一种方法可能是远程医疗系统，在该系统中，由阅片者对高危婴儿的视网膜图像进行分级，以确定ROP的特征，从而判断是否需要进行诊断检查。
多中心评估急性期ROP的远程医疗方法（e-ROP）研究是一项针对2000名出生体重<1251克婴儿的队列研究。每次就诊时，眼科医生进行诊断检查，非医生成像人员获取虹膜图像以及五张视网膜图像，视盘分别位于中心、右侧、左侧、上方和下方。图像上传至安全服务器，由非医生阅片者进行分级，以检测Plus病变、3期ROP和/或I区病变，其中任何一种均表明“需转诊的ROP”（RW-ROP）。选取所有患有RW-ROP的婴儿以及随机抽取的无RW-ROP婴儿（基于诊断检查结果）的图像进行分级。将分级结果与诊断检查结果进行比较，以确定远程医疗系统的有效性，并评估其可靠性、可行性、安全性和成本效益。
e-ROP研究在美国和加拿大的12个临床中心开展，研究总部、数据协调中心和图像阅读中心位于费城，ROP数据中心位于俄克拉何马城。共有27名研究中心协调员、34名眼科医生、26名成像人员和4名阅片者获得认证。所有研究数据均通过安全的基于网络的系统提交。
本研究的设计和结果将有助于开展其他ROP研究或评估针对其他疾病的远程医疗。
