Telemedicine in retinopathy of prematurity: challenges and perspectives

Document Type : Review Article

Authors

1 Assistant Professor of Ophthalmology, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Fellowship assistant of vitreoretinal surgery, Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

10.22038/nnj.2025.81829.1457

Abstract

Background and Aims: Retinopathy of Prematurity (ROP), a serious eye disease affecting premature infants, requires careful and frequent examinations. Improvement in technology and health care systems in neonatal intensive care units leads to higher survival of premature neonates and an increasing trend of retinopathy of prematurity prevalence.
Materials and Methods: To prepare this review article, a comprehensive search was conducted in PubMed, Scopus, Web of Science, and Google Scholar databases. Articles after 2005 were evaluated. The search terms included combinations of the following words: "Retinopathy of Prematurity," "ROP Screening," "Telemedicine," "Artificial Intelligence in Ophthalmology," "Remote Screening," and "Neonatal Retinopathy Diagnosis."
Results: With the advent of telemedicine, physicians can consult and examine remotely, which can help reduce the need for frequent trips and related costs.
Conclusion: This article explores the potential benefits of telemedicine in managing retinopathy of prematurity, including enhanced access to specialized medical care and improved monitoring of the treatment process. It also analyzes the major challenges, such as technical problems, technology limitations, and the need for high accuracy standards, and offers suggestions for improving and developing this method. Ultimately, the future of telemedicine in this field is envisioned as a new and effective tool for enhancing treatment outcomes and alleviating the financial burden on healthcare systems.

Keywords

References

[1] Dammann O, Hartnett ME, Stahl A. Retinopathy of prematurity. Developmental Medicine & Child Neurology. 2023;65(5):625-631.
[2] Prakalapakorn SG, Greenberg L, Edwards EM, Ehret DE. Trends in retinopathy of prematurity screening and treatment: 2008–2018. Pediatrics. 2021;147(6). 
[3] Sabri K, Ells AL, Lee EY, Dutta S, Vinekar A. Retinopathy of prematurity: a global perspective and recent developments. Pediatrics. 2022;150(3). 
[4] Brady CJ, D'amico S, Campbell JP. Telemedicine for retinopathy of prematurity. Telemedicine and e-Health. 2020;26(4):556-564.
[5] Al-Khaled T, Valikodath NG, Patel SN, Cole E, Chervinko M, Douglas CE, et al. Addressing the third epidemic of retinopathy of prematurity through telemedicine and technology: a systematic review. Journal of Pediatric Ophthalmology & Strabismus. 2021;58(4):261-269.      
[6] Antaki F, Bachour K, Kim TN, Qian CX. The role of telemedicine to alleviate an increasingly burdened healthcare system: Retinopathy of prematurity. Ophthalmology and therapy. 2020;9:449-464.
[7] Kim E, Nguyen K-H, Donovan T, Edirippulige S, Armfield NR. A cost-minimisation analysis comparing alternative telemedicine screening approaches for retinopathy of prematurity. Journal of Telemedicine and Telecare. 2023;29(3):196-202.    
[8] Maka E, Kovács G, Imre L, Gilbert C, Szabó M, Nemeth J, et al. The validity of telemedicine-based screening for retinopathy of prematurity in the Premature Eye Rescue Program in Hungary. Journal of Telemedicine and Telecare. 2021;27(6):367-375. 
[9] Makkar A, Michael Siatkowski R, Szyld E, Ganguly A, Sekar K. Scope of telemedicine in neonatology. Chinese Journal of Contemporary Pediatrics. 2020;22(5).
[10] Arnold RW, LaMattina KC, Taylormoore J, Nelson LB. Experiences in telemedicine for pediatric ophthalmology. Journal of Pediatric Ophthalmology & Strabismus. 2020;57(6):344-347.
[11] Ells AL, Holmes JM, Astle WF, Williams G, Leske DA, Fielden M, et al. Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study. Ophthalmology. 2003;110(11):2113-2117.
[12] Richter GM, Williams SL, Starren J, Flynn JT, Chiang MF. Telemedicine for retinopathy of prematurity diagnosis: evaluation and challenges. Survey of ophthalmology. 2009;54(6):671-685.
[13] Shah PK, Ramya A, Narendran V. Telemedicine for ROP. Asia-Pacific Journal of Ophthalmology. 2018;7(1):52-55.
[14] Kovács G, Somogyvári Z, Maka E, Nagyjánosi L. Bedside ROP screening and telemedicine interpretation integrated to a neonatal transport system: Economic aspects and return on investment analysis. Early Human Development. 2017;106:1-5.    
[15] Vinekar A, Mangalesh S, Jayadev C, Gilbert C, Dogra M, Shetty B. Impact of expansion of telemedicine screening for retinopathy of prematurity in India. Indian journal of ophthalmology. 2017;65(5):390-395.
[16] Vinekar A, Jayadev C, Bauer N. Need for telemedicine in retinopathy of prematurity in middle-income countries: e-ROP vs KIDROP. JAMA ophthalmology. 2015;133(3):360-361.
[17] Skalet AH, Quinn GE, Ying G-S, Gordillo L, Dodobara L, Cocker K, et al. Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2008;12(3):252-258.
[18] Ossandón D, Zanolli M, Stevenson R, Agurto R, Ortiz P, Dotan G. A national telemedicine network for retinopathy of prematurity screening. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2018;22(2):124-127.    
[19] Goyal A, Gopalakrishnan M, Anantharaman G, Chandrashekharan DP, Thachil T, Sharma A. Smartphone guided wide-field imaging for retinopathy of prematurity in neonatal intensive care unit–a Smart ROP (SROP) initiative. Indian journal of ophthalmology. 2019;67(6):840-845. 
[20] Chan H, Cougnard-Grégoire A, Korobelnik J-F, Delyfer M-N, Touboul D, Coste V, et al. Screening for retinopathy of prematurity by telemedicine in a tertiary level neonatal intensive care unit in France: Review of a six-year period. Journal Français d'Ophtalmologie. 2018;41(10):926-932.
[21] Slaveykov K, Trifonova K, Stoyanov V. PRACTICAL USES OF TELEOPHTHALMOLOGY. Science & Research. 2019.
[22] Moshfeghi DM, Capone A. Economic barriers in retinopathy of prematurity management. Ophthalmology Retina. 2018;2(12):1177-1178. 
[23] Bowe T, Ung C, Campbell JP, Yonekawa Y. Telemedicine for retinopathy of prematurity in 2020. Journal of vitreoretinal diseases. 2019;3(6):452-458.         
[24] Lanzelotte V, Vieira AA, Fonseca ABM, da Silva JE, Gonet B, Bueno AC. ROP screening with the Pictor Plus camera: a telemedicine solution for developing countries. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2022;26(5):244.e1-246.
[25] Nittari G, Khuman R, Baldoni S, Pallotta G, Battineni G, Sirignano A, et al. Telemedicine practice: review of the current ethical and legal challenges. Telemedicine and e-Health. 2020;26(12):1427-1437.
[26] Gioia G, Salducci M. Medical and legal aspects of telemedicine in ophthalmology. Romanian journal of ophthalmology. 2019; 63 (3):197.         
[27] Mazzuca D, Borselli M, Gratteri S, Zampogna G, Feola A, Della Corte M, et al. Applications and current medico-legal challenges of telemedicine in ophthalmology. International journal of environmental research and public health. 2022;19 (9):5614.         
[28] Almadhi NH, Dow ER, Chan RP, Alsulaiman SM. Multimodal Imaging, Tele-Education, and Telemedicine in Retinopathy of Prematurity. Middle East African Journal of Ophthalmology. 2022; 29 (1):38-50.
[29] Bao Y, Ming W-K, Mou Z-W, Kong Q-H, Li A, Yuan T-F, et al. Current application of digital diagnosing systems for retinopathy of prematurity. Computer methods and programs in biomedicine. 2021;200:105871.
[30] Vijayalakshmi C, Sakthivel P, Vinekar A. Automated detection and classification of telemedical retinopathy of prematurity images. Telemedicine and e-Health. 2020; 26 (3):354-358.  
[31] Luo Z, Ding X, Hou N, Wan J. A deep-learning-based collaborative edge–cloud telemedicine system for retinopathy of prematurity. Sensors. 2022; 23 (1):276.         
[32] Shah S, Slaney E, VerHage E, Chen J, Dias R, Abdelmalik B, et al. Application of artificial intelligence in the early detection of retinopathy of prematurity: review of the literature. Neonatology. 2023;120(5):558-565.
[33] Barrero-Castillero A, Corwin BK, VanderVeen DK, Wang JC. Workforce shortage for retinopathy of prematurity care and emerging role of telehealth and artificial intelligence. Pediatric Clinics. 2020;67(4):725-733.
[34] Smith AF, Sadeq A, Kinzel E, Bhambhwani V. A systematic review of economic evaluations conducted for interventions to screen, treat, and manage retinopathy of prematurity (ROP) in the United States, United Kingdom, and Canada. Ophthalmic Epidemiology. 2023;30(2):113-120.
[35] Fijalkowski N, Zheng LL, Henderson MT, Wallenstein MB, Leng T, Moshfeghi DM. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): four-years of screening with telemedicine. Current eye research. 2013;38(2):283-291.  
[36] Quinn GE, Ying G-s, Daniel E, Hildebrand PL, Ells A, Baumritter A, et al. Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity. JAMA ophthalmology. 2014;132(10):1178-1184.
[37] Daniel E, Quinn GE, Hildebrand PL, Ells A, Hubbard GB, Capone A, et al. Validated system for centralized grading of retinopathy of prematurity: telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study. JAMA ophthalmology. 2015;133(6):675-682.
[38] Jackson KM, Scott KE, Zivin JG, Bateman DA, Flynn JT, Keenan JD, et al. Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management. Archives of Ophthalmology. 2008;126(4):493-499.

Navid No
Volume 27, Issue 92
March 2025
Pages 70-81

Files

Share

How to cite

Statistics