Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: A feasibility project
Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: A feasibility project
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DOI：
10.1016/j.jaapos.2007.11.009
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发表时间：
2008-06-01
期刊：
影响因子：
1.6
通讯作者：
Gilbert, Clare
中科院分区：
文献类型：
--
作者：
Skalet, Alison H.;Quinn, Graham E.;Gilbert, Clare
目的确定在一个中等水平的人类发展国家的现场培训，图像收集，互联网传输，并从早产儿视网膜病变（ROP）筛查婴儿的数字视网膜图像的远程分级的可行性。方法两名经验丰富的护士在新生儿托儿所在秘鲁，接受培训，以采取后极（30度）数字视网膜图像。护士从接受常规ROP筛查的婴儿中获得后极视网膜图像，并选择图像通过互联网上传，由五名蒙面ROP专家进行远程评估。将分级结果与同一天由经验丰富的眼科医生进行的临床诊断检查进行比较。成功率的图像采集和传输的分级由专家readers.Results系列图像集从2 6的2 8名婴儿参加了这项研究，两个婴儿是太不稳定的成像。五十六的58（96.6%）成像会话成功地获得视网膜图像。获得的336张图像中有330张（98.2%）成功上传到交互式数据库。远程分级员判断93.6%至97.3%的图像集适合ROP分级。初步结果表明，从45.5%至95.2%的个别读者，与特异性的61.7%至96.2%的图像分级时，检测严重的ROP的灵敏度是gradable.CONCLUSIONS远程医疗方法ROP筛选使用数字视网膜图像获得的nonophthalmologists是可行的，在快速发展的国家，缺乏ROP培训的眼科医生。如果数字图像的远程分级被验证为用于识别眼科保证的ROP（RW-ROP）的有效方法，则由非医生获得的图像可以提供识别需要眼科医生进行诊断检查的婴儿的手段。
PURPOSE To determine the feasibility in a middle-level human development country of onsite training, image collection, Internet transfer, and remote grading of digital retinal images from babies screened for retinopathy of prematurity (ROP).METHODS Two experienced nurses in a neonatal nursery in Lima, Peru, were trained to take posterior pole (30 degrees) digital retinal images. Nurses obtained posterior pole retinal images from babies undergoing routine ROP screening and selected images for uploading via Internet for remote evaluation by five masked ROP experts. Results of gradings were compared with same-day clinical diagnostic examinations by an experienced ophthalmologist. Success rates for image acquisition and transfer for grading by expert readers were calculated.RESULTS Serial image sets from 2 6 of the 2 8 babies enrolled in this study were obtained; two babies were too unstable for imaging. Fifty-six of 58 (96.6%) imaging sessions were successful in obtaining retinal images. Three hundred thirty of 336 (98.2%) images obtained were successfully uploaded to an interactive database. Remote graders judged 93.6% to 97.3% of image sets suitable for ROP grading. Preliminary results indicate sensitivities for detection of serious ROP from 45.5% to 95.2% among individual readers, with specificities of 61.7% to 96.2% when images were gradable.CONCLUSIONS A telemedicine approach for ROP screening using digital retinal images obtained by nonophthalmologists is feasible in rapidly developing countries that lack ROP-trained ophthalmologists. If remote grading of digital images is validated as an effective method for identifying referral-warranted ROP (RW-ROP), images obtained by nonphysicians may provide a means of identifying babies who require a diagnostic examination by an ophthalmologist.