Telemedicine Utilization for Retinopathy of Prematurity Screening in Premature Infants: Systematic Review and Meta-Analysis.

TOPIC: The purpose of this study was to report the sensitivities and specificities of telemedicine technology used to screen for referral-warranted (RW)-retinopathy of prematurity (ROP) and treatment-required (TR)-ROP.

CLINICAL RELEVANCE: Retinopathy of prematurity is a leading cause of blindness in premature infants. Tele-ROP has emerged as a novel method to help screen for ROP in low-resource locations and showcases significant promise.

METHODS

PubMed, Embase, and Web of Science databases were searched from January 2000 to October 2024. Studies reporting sensitivities and specificities of RW-ROP or TR-ROP were included in the meta-analysis. These values were combined using random-effects meta-analysis. Risk of bias was determined via the Newcastle Ottawa Scale and Quality Assessment of Diagnostic Accuracy Studies-2 tool. The study protocol was registered and published on the International Prospective Register of Systematic Reviews (CRD42024608378).

RESULTS

Of 905 identified studies, 16 studies met the inclusion criteria and were thus included in the meta-analysis. Of 3527 patients, 6149 eyes were studied. The sensitivity in the RW group was 0.93 (95% CI, 0.83-0.98), with low heterogeneity between studies (I2 = 0.0%; P = 0.75), and the overall specificity was 0.95 (95% CI, 0.85-0.98), with heterogeneity between studies (I2 = 91.2%; P < 0.001). Certainty of evidence was graded as moderate for sensitivity and high for specificity using the GRADE approach. Regarding the TR-ROP group, the sensitivity was 0.97 (95% CI, 0.92-0.99), with low heterogeneity between studies (I2 = 0.0%; P = 0.97), and the specificity was 0.97 (95% CI, 0.91-0.99), with heterogeneity between studies (I2 = 88.2%; P < 0.001). Certainty of evidence was graded as high. Post-2010 studies had greater sensitivities and specificities for RW-ROP: P < 0.001 and P = 0.77, respectively. Treatment-required -ROP sensitivity and specificity were higher in studies conducted after 2010 than prior: P = 0.06 and P < 0.001, respectively. Sensitivity and specificity for US vs. non-US-based studies were (0.83 vs. 0.92, P = 0.012) and (0.97 vs. 0.88, P = 0.04), respectively. Specificity for TR-ROP between US vs. non-US-based studies was 0.98 vs. 0.95, P < 0.001, respectively.

CONCLUSION

Remote digital fundus imaging may be an option for ROP screening, particularly in low-resource areas. There was significant variability. This suggests a need for continued formal training for both photographers and graders.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.