Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity

Graham E. Quinn; Gui Shuang Ying; Ebenezer Daniel; P. Lloyd Hildebrand; Anna Ells; Agnieshka Baumritter; Alex R. Kemper; Eleanor B. Schron; Kelly Wade; Trang B. Duros; Lisa Erbring; Michael X. Repka; Jennifer A. Shepard; Pamela Donohue; David Emmert; C. Mark Herring; Deborah VanderVeen; Suzanne Johnston; Carolyn Wu; Jason Mantagos; Danielle Ledoux; Tamar Winter; Frank Weng; Theresa Mansfield; Don L. Bremer; Richard Golden; Mary Lou McGregor; Catherine Olson Jordan; David L. Rogers; Rae R. Fellows; Suzanne Brandt; Brenda Mann; David Wallace; Sharon Freedman; Sarah K. Jones; Du Tran-Viet; Rhonda Michelle Young; Charles C. Barr; Rahul Bhola; Craig Douglas; Peggy Fishman; Michelle Bottorff; Brandi Hubbuch; Rachel Keith; Erick D. Bothun; Inge DeBecker; Jill Anderson; Ann Marie Holleschau; Nichole E. Miller; Darla N. Nyquist; R. Michael Siatkowski; Lucas Trigler; Marilyn Escobedo; Karen Corff; Michelle Huynh-Blunt; Kelli Satnes; Monte D. Mills; Will Anninger; Gil Binenbaum; Karen A. Karp; Denise Pearson; Alice Gong; John Stokes; Clio Armitage Harper; Laurie Weaver; Carmen McHenry; Kathryn Conner; Rosalind Heemer; Elnora Cokley; Robin Tragus; Robert Hoffman; David Dries; Katie Jo Farnsworth; Deborah Harrison; Bonnie Carlstrom; Cyrie Ann Frye; David Morrison; Sean Donahue; Nancy Benegas; Sandy Owings; Sandra Phillips; Scott Ruark; Patrick Mitchell; April Ingram; Rosie Sorbie; Maureen Maguire; Mary Brightwell-Arnold; Max Pistilli; Kathleen McWilliams; Sandra Harris; Claressa Whearry; E. Revell Martin; Candace R. Parker Ostroff; Krista Sepielli; Eli Smith; Antonio Capone; G. Baker Hubbard; Kerry Davis; G. Carl Gibson; Regina Hansen; Lisa Prosser; David C. Musch; Stephen P. Christiansen; Ditte J. Hess; Steven M. Kymes; Srinivas R. Sadda; Ryan Spaulding

doi:10.1001/jamaophthalmol.2014.1604

Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity

Graham E. Quinn, Gui Shuang Ying, Ebenezer Daniel, P. Lloyd Hildebrand, Anna Ells, Agnieshka Baumritter, Alex R. Kemper, Eleanor B. Schron, Kelly Wade, Trang B. Duros, Lisa Erbring, Michael X. Repka, Jennifer A. Shepard, Pamela Donohue, David Emmert, C. Mark Herring, Deborah VanderVeen, Suzanne Johnston, Carolyn Wu, Jason MantagosDanielle Ledoux, Tamar Winter, Frank Weng, Theresa Mansfield, Don L. Bremer, Richard Golden, Mary Lou McGregor, Catherine Olson Jordan, David L. Rogers, Rae R. Fellows, Suzanne Brandt, Brenda Mann, David Wallace, Sharon Freedman, Sarah K. Jones, Du Tran-Viet, Rhonda Michelle Young, Charles C. Barr, Rahul Bhola, Craig Douglas, Peggy Fishman, Michelle Bottorff, Brandi Hubbuch, Rachel Keith, Erick D. Bothun, Inge DeBecker, Jill Anderson, Ann Marie Holleschau, Nichole E. Miller, Darla N. Nyquist, R. Michael Siatkowski, Lucas Trigler, Marilyn Escobedo, Karen Corff, Michelle Huynh-Blunt, Kelli Satnes, Monte D. Mills, Will Anninger, Gil Binenbaum, Karen A. Karp, Denise Pearson, Alice Gong, John Stokes, Clio Armitage Harper, Laurie Weaver, Carmen McHenry, Kathryn Conner, Rosalind Heemer, Elnora Cokley, Robin Tragus, Robert Hoffman, David Dries, Katie Jo Farnsworth, Deborah Harrison, Bonnie Carlstrom, Cyrie Ann Frye, David Morrison, Sean Donahue, Nancy Benegas, Sandy Owings, Sandra Phillips, Scott Ruark, Patrick Mitchell, April Ingram, Rosie Sorbie, Maureen Maguire, Mary Brightwell-Arnold, Max Pistilli, Kathleen McWilliams, Sandra Harris, Claressa Whearry, E. Revell Martin, Candace R. Parker Ostroff, Krista Sepielli, Eli Smith, Antonio Capone, G. Baker Hubbard, Kerry Davis, G. Carl Gibson, Regina Hansen, Lisa Prosser, David C. Musch, Stephen P. Christiansen, Ditte J. Hess, Steven M. Kymes, Srinivas R. Sadda, Ryan Spaulding

Ophthalmology & Visual Neurosciences

Research output: Contribution to journal › Article › peer-review

175 Scopus citations

Abstract

CONCLUSIONS AND RELEVANCE: When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP.

INTERVENTIONS: Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements.

MAIN OUTCOMES AND MEASURES: The validity of grading retinal image setswas based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination.

ESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2%of eyes (19.4%of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95%CI, 77.4-85.6) and specificity of 90.1% (95%CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0%(95%CI, 85.4-93.5), with specificity of 87.0% (95%CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5%at the observed RW-ROP rate of 19.4%.

DESIGN, SETTING, AND PARTICIPANTS: An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013.

IMPORTANCE: The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy.

OBJECTIVE: To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist.

Original language	English (US)
Pages (from-to)	1178-1184
Number of pages	7
Journal	JAMA Ophthalmology
Volume	132
Issue number	10
DOIs	https://doi.org/10.1001/jamaophthalmol.2014.1604
State	Published - Oct 1 2014

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© 2014 American Medical Association. All rights reserved.

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Quinn, G. E., Ying, G. S., Daniel, E., Hildebrand, P. L., Ells, A., Baumritter, A., Kemper, A. R., Schron, E. B., Wade, K., Duros, T. B., Erbring, L., Repka, M. X., Shepard, J. A., Donohue, P., Emmert, D., Herring, C. M., VanderVeen, D., Johnston, S., Wu, C., ... Spaulding, R. (2014). Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity. JAMA Ophthalmology, 132(10), 1178-1184. https://doi.org/10.1001/jamaophthalmol.2014.1604

Quinn, GE, Ying, GS, Daniel, E, Hildebrand, PL, Ells, A, Baumritter, A, Kemper, AR, Schron, EB, Wade, K, Duros, TB, Erbring, L, Repka, MX, Shepard, JA, Donohue, P, Emmert, D, Herring, CM, VanderVeen, D, Johnston, S, Wu, C, Mantagos, J, Ledoux, D, Winter, T, Weng, F, Mansfield, T, Bremer, DL, Golden, R, McGregor, ML, Jordan, CO, Rogers, DL, Fellows, RR, Brandt, S, Mann, B, Wallace, D, Freedman, S, Jones, SK, Tran-Viet, D, Young, RM, Barr, CC, Bhola, R, Douglas, C, Fishman, P, Bottorff, M, Hubbuch, B, Keith, R, Bothun, ED, DeBecker, I, Anderson, J , Holleschau, AM, Miller, NE, Nyquist, DN, Siatkowski, RM, Trigler, L, Escobedo, M, Corff, K, Huynh-Blunt, M, Satnes, K, Mills, MD, Anninger, W, Binenbaum, G, Karp, KA, Pearson, D, Gong, A, Stokes, J, Harper, CA, Weaver, L, McHenry, C, Conner, K, Heemer, R, Cokley, E, Tragus, R, Hoffman, R, Dries, D, Farnsworth, KJ, Harrison, D, Carlstrom, B, Frye, CA, Morrison, D, Donahue, S, Benegas, N, Owings, S, Phillips, S, Ruark, S, Mitchell, P, Ingram, A, Sorbie, R, Maguire, M, Brightwell-Arnold, M, Pistilli, M, McWilliams, K, Harris, S, Whearry, C, Martin, ER, Parker Ostroff, CR, Sepielli, K, Smith, E, Capone, A, Hubbard, GB, Davis, K, Gibson, GC, Hansen, R, Prosser, L, Musch, DC, Christiansen, SP, Hess, DJ, Kymes, SM, Sadda, SR & Spaulding, R 2014, 'Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity', JAMA Ophthalmology, vol. 132, no. 10, pp. 1178-1184. https://doi.org/10.1001/jamaophthalmol.2014.1604

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abstract = "CONCLUSIONS AND RELEVANCE: When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP.INTERVENTIONS: Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements.MAIN OUTCOMES AND MEASURES: The validity of grading retinal image setswas based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination.ESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2%of eyes (19.4%of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95%CI, 77.4-85.6) and specificity of 90.1% (95%CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0%(95%CI, 85.4-93.5), with specificity of 87.0% (95%CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5%at the observed RW-ROP rate of 19.4%.DESIGN, SETTING, AND PARTICIPANTS: An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013.IMPORTANCE: The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy.OBJECTIVE: To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist.",

author = "Quinn, {Graham E.} and Ying, {Gui Shuang} and Ebenezer Daniel and Hildebrand, {P. Lloyd} and Anna Ells and Agnieshka Baumritter and Kemper, {Alex R.} and Schron, {Eleanor B.} and Kelly Wade and Duros, {Trang B.} and Lisa Erbring and Repka, {Michael X.} and Shepard, {Jennifer A.} and Pamela Donohue and David Emmert and Herring, {C. Mark} and Deborah VanderVeen and Suzanne Johnston and Carolyn Wu and Jason Mantagos and Danielle Ledoux and Tamar Winter and Frank Weng and Theresa Mansfield and Bremer, {Don L.} and Richard Golden and McGregor, {Mary Lou} and Jordan, {Catherine Olson} and Rogers, {David L.} and Fellows, {Rae R.} and Suzanne Brandt and Brenda Mann and David Wallace and Sharon Freedman and Jones, {Sarah K.} and Du Tran-Viet and Young, {Rhonda Michelle} and Barr, {Charles C.} and Rahul Bhola and Craig Douglas and Peggy Fishman and Michelle Bottorff and Brandi Hubbuch and Rachel Keith and Bothun, {Erick D.} and Inge DeBecker and Jill Anderson and Holleschau, {Ann Marie} and Miller, {Nichole E.} and Nyquist, {Darla N.} and Siatkowski, {R. Michael} and Lucas Trigler and Marilyn Escobedo and Karen Corff and Michelle Huynh-Blunt and Kelli Satnes and Mills, {Monte D.} and Will Anninger and Gil Binenbaum and Karp, {Karen A.} and Denise Pearson and Alice Gong and John Stokes and Harper, {Clio Armitage} and Laurie Weaver and Carmen McHenry and Kathryn Conner and Rosalind Heemer and Elnora Cokley and Robin Tragus and Robert Hoffman and David Dries and Farnsworth, {Katie Jo} and Deborah Harrison and Bonnie Carlstrom and Frye, {Cyrie Ann} and David Morrison and Sean Donahue and Nancy Benegas and Sandy Owings and Sandra Phillips and Scott Ruark and Patrick Mitchell and April Ingram and Rosie Sorbie and Maureen Maguire and Mary Brightwell-Arnold and Max Pistilli and Kathleen McWilliams and Sandra Harris and Claressa Whearry and Martin, {E. Revell} and {Parker Ostroff}, {Candace R.} and Krista Sepielli and Eli Smith and Antonio Capone and Hubbard, {G. Baker} and Kerry Davis and Gibson, {G. Carl} and Regina Hansen and Lisa Prosser and Musch, {David C.} and Christiansen, {Stephen P.} and Hess, {Ditte J.} and Kymes, {Steven M.} and Sadda, {Srinivas R.} and Ryan Spaulding",

year = "2014",

month = oct,

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doi = "10.1001/jamaophthalmol.2014.1604",

language = "English (US)",

volume = "132",

pages = "1178--1184",

journal = "JAMA Ophthalmology",

issn = "2168-6165",

publisher = "American Medical Association",

number = "10",

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TY - JOUR

T1 - Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity

AU - Quinn, Graham E.

AU - Ying, Gui Shuang

AU - Daniel, Ebenezer

AU - Hildebrand, P. Lloyd

AU - Ells, Anna

AU - Baumritter, Agnieshka

AU - Kemper, Alex R.

AU - Schron, Eleanor B.

AU - Wade, Kelly

AU - Duros, Trang B.

AU - Erbring, Lisa

AU - Repka, Michael X.

AU - Shepard, Jennifer A.

AU - Donohue, Pamela

AU - Emmert, David

AU - Herring, C. Mark

AU - VanderVeen, Deborah

AU - Johnston, Suzanne

AU - Wu, Carolyn

AU - Mantagos, Jason

AU - Ledoux, Danielle

AU - Winter, Tamar

AU - Weng, Frank

AU - Mansfield, Theresa

AU - Bremer, Don L.

AU - Golden, Richard

AU - McGregor, Mary Lou

AU - Jordan, Catherine Olson

AU - Rogers, David L.

AU - Fellows, Rae R.

AU - Brandt, Suzanne

AU - Mann, Brenda

AU - Wallace, David

AU - Freedman, Sharon

AU - Jones, Sarah K.

AU - Tran-Viet, Du

AU - Young, Rhonda Michelle

AU - Barr, Charles C.

AU - Bhola, Rahul

AU - Douglas, Craig

AU - Fishman, Peggy

AU - Bottorff, Michelle

AU - Hubbuch, Brandi

AU - Keith, Rachel

AU - Bothun, Erick D.

AU - DeBecker, Inge

AU - Anderson, Jill

AU - Holleschau, Ann Marie

AU - Miller, Nichole E.

AU - Nyquist, Darla N.

AU - Siatkowski, R. Michael

AU - Trigler, Lucas

AU - Escobedo, Marilyn

AU - Corff, Karen

AU - Huynh-Blunt, Michelle

AU - Satnes, Kelli

AU - Mills, Monte D.

AU - Anninger, Will

AU - Binenbaum, Gil

AU - Karp, Karen A.

AU - Pearson, Denise

AU - Gong, Alice

AU - Stokes, John

AU - Harper, Clio Armitage

AU - Weaver, Laurie

AU - McHenry, Carmen

AU - Conner, Kathryn

AU - Heemer, Rosalind

AU - Cokley, Elnora

AU - Tragus, Robin

AU - Hoffman, Robert

AU - Dries, David

AU - Farnsworth, Katie Jo

AU - Harrison, Deborah

AU - Carlstrom, Bonnie

AU - Frye, Cyrie Ann

AU - Morrison, David

AU - Donahue, Sean

AU - Benegas, Nancy

AU - Owings, Sandy

AU - Phillips, Sandra

AU - Ruark, Scott

AU - Mitchell, Patrick

AU - Ingram, April

AU - Sorbie, Rosie

AU - Maguire, Maureen

AU - Brightwell-Arnold, Mary

AU - Pistilli, Max

AU - McWilliams, Kathleen

AU - Harris, Sandra

AU - Whearry, Claressa

AU - Martin, E. Revell

AU - Parker Ostroff, Candace R.

AU - Sepielli, Krista

AU - Smith, Eli

AU - Capone, Antonio

AU - Hubbard, G. Baker

AU - Davis, Kerry

AU - Gibson, G. Carl

AU - Hansen, Regina

AU - Prosser, Lisa

AU - Musch, David C.

AU - Christiansen, Stephen P.

AU - Hess, Ditte J.

AU - Kymes, Steven M.

AU - Sadda, Srinivas R.

AU - Spaulding, Ryan

PY - 2014/10/1

Y1 - 2014/10/1

N2 - CONCLUSIONS AND RELEVANCE: When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP.INTERVENTIONS: Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements.MAIN OUTCOMES AND MEASURES: The validity of grading retinal image setswas based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination.ESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2%of eyes (19.4%of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95%CI, 77.4-85.6) and specificity of 90.1% (95%CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0%(95%CI, 85.4-93.5), with specificity of 87.0% (95%CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5%at the observed RW-ROP rate of 19.4%.DESIGN, SETTING, AND PARTICIPANTS: An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013.IMPORTANCE: The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy.OBJECTIVE: To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist.

AB - CONCLUSIONS AND RELEVANCE: When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP.INTERVENTIONS: Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements.MAIN OUTCOMES AND MEASURES: The validity of grading retinal image setswas based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination.ESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2%of eyes (19.4%of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95%CI, 77.4-85.6) and specificity of 90.1% (95%CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0%(95%CI, 85.4-93.5), with specificity of 87.0% (95%CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5%at the observed RW-ROP rate of 19.4%.DESIGN, SETTING, AND PARTICIPANTS: An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013.IMPORTANCE: The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy.OBJECTIVE: To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist.

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Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity

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