Photographic Artifact Resembling International Classification of Retinopathy of Prematurity Stage One and Two Description.

This report presents a retrospective case series of fundus photography artifacts encountered during telemedicine-based retinopathy of prematurity (ROP) screenings that closely resemble stage 1 and 2 ROP as defined by the International Classification of Retinopathy of Prematurity (ICROP). Images were obtained from preterm infants undergoing routine ROP screening through Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) and TeleROP telemedicine screening programs using the RetCam Envision 130° pediatric camera. Photographs taken by trained neonatal intensive care unit nurses were securely transmitted to ROP specialists for interpretation. Review of the photographs revealed several artifacts that appeared similar to early-stage ROP. Artifacts notably shifted position across multiple redundant images and retinal vessels extended beyond the demarcation line, confirming their nonpathologic nature. Awareness of these imaging artifacts is critical for ophthalmologists involved in ROP diagnosis and management. Comparing multiple images from slightly different angles allows graders to reliably distinguish artifacts from true ROP pathology, thereby avoiding misdiagnosis and unnecessary interventions.