Smartphone-based fundus documentation in retinopathy of prematurity.
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ABSTRACT:
SUBMITTER: Raju B
PROVIDER: S-EPMC6836609 | biostudies-literature | 2019 Nov
REPOSITORIES: biostudies-literature
Publications
Smartphone-based fundus documentation in retinopathy of prematurity.
Raju Biju B Raju N S D NSD Akkara John Davis JD Pathengay Avinash A
Indian journal of ophthalmology 20191101 11
Similar Datasets
Project description:Retinopathy of prematurity (ROP) is a frequent cause of treatable childhood blindness. The current dependency of telemedicine-based ROP screening on cost-intensive equipment does not meet the needs in economically disadvantaged regions. Smartphone-based fundus imaging (SBFI) allows for affordable and mobile fundus examination and, therefore, could facilitate cost-effective telemedicine-based ROP screening in low-resources settings. We compared non-contact SBFI and conventional contact fundus imaging (CFI) in terms of feasibility for ROP screening and documentation. Twenty-six eyes were imaged with both SBFI and CFI. Field-of-view was smaller (ratio of diameters, 1:2.5), level of detail was equal, and examination time was longer for SBFI as compared to CFI (109.0 ± 57.8 vs. 75.9 ± 36.3 seconds, p < 0.01). Good agreement with clinical evaluation by indirect funduscopy was achieved for assessment of plus disease and ROP stage for both SBFI (squared Cohen's kappa, 0.88 and 0.81, respectively) and CFI (0.86 and 0.93). Likewise, sensitivity/specificity for detection of plus disease and ROP was high for both SBFI (90%/100% and 88%/93%, respectively) and CFI (80%/100% and 100%/96%). SBFI is a non-contact and low-cost alternative to CFI for ROP screening and documentation that has the potential to considerably improve ROP care in middle- and low-resources settings.
| S-EPMC6928229 | biostudies-literature
Project description:Background/objectivesRetinopathy of prematurity (ROP) is a potentially blinding disease of immature retinal vasculature. ROP regresses in majority of the cases and very few go on to develop ROP needing treatment. Fundus fluorescein angiography (FFA) is the gold standard technique to study retinal vasculature. The present study was undertaken with the objective to identify the FFA findings associated with the progression of ROP.Subject/methodsProspective single centre study in a tertiary care hospital of 99 eyes of 50 preterm babies. Fundus fluorescein angiography (FFA) was performed in all babies using RetCam 3 at the first detection of ROP. The babies were followed up for the progression of ROP. The FFA predictors for the progression of ROP were evaluated using the Mann-Whitney U test and Fisher's test.ResultsThirty-eight eyes were Type 1 ROP at initial presentation and were lasered. Amongst the rest, 24 eyes showed features of stage 3 ROP with intense leakage on FFA and were designated as FFA-treatable ROP and were also lasered. Amongst the rest of the 37 eyes, the disease progression was seen in 13 eyes and the disease regression was seen in 24 eyes. The baseline FFA findings associated with the progression of ROP were delayed retinal arterial perfusion (p = 0.037) and popcorn lesions (p = 0.042). The post hoc analysis was done using a validated FFA scoring system.ConclusionsFFA may be added in the classification of ROP and delayed retinal arterial perfusion and popcorn lesions on FFA may predict the progression of ROP.
| S-EPMC9307517 | biostudies-literature
Project description:BackgroundSmartphone-based fundus imaging allows for mobile and inexpensive fundus examination with the potential to revolutionize eye care, particularly in lower-resource settings. However, most smartphone-based fundus imaging adapters convey image quality not comparable to conventional fundus imaging.ObjectiveThe purpose of this study was to evaluate a novel smartphone-based fundus imaging device for documentation of a variety of retinal/vitreous pathologies in a patient sample with wide refraction and age ranges.MethodsParticipants' eyes were dilated and imaged with the iC2 funduscope (HEINE Optotechnik) using an Apple iPhone 6 in single-image acquisition (image resolution of 2448 × 3264 pixels) or video mode (1248 × 1664 pixels) and a subgroup of participants was also examined by conventional fundus imaging (Zeiss VISUCAM 500). Smartphone-based image quality was compared to conventional fundus imaging in terms of sharpness (focus), reflex artifacts, contrast, and illumination on semiquantitative scales.ResultsA total of 47 eyes from 32 participants (age: mean 62.3, SD 19.8 years; range 7-93; spherical equivalent: mean -0.78, SD 3.21 D; range: -7.88 to +7.0 D) were included in the study. Mean (SD) visual acuity (logMAR) was 0.48 (0.66; range 0-2.3); 30% (14/47) of the eyes were pseudophakic. Image quality was sufficient in all eyes irrespective of refraction. Images acquired with conventional fundus imaging were sharper and had less reflex artifacts, and there was no significant difference in contrast and illumination (P<.001, P=.03, and P=.10, respectively). When comparing image quality at the posterior pole, the mid periphery, and the far periphery, glare increased as images were acquired from a more peripheral part of the retina. Reflex artifacts were more frequent in pseudophakic eyes. Image acquisition was also possible in children. Documentation of deep optic nerve cups in video mode conveyed a mock 3D impression.ConclusionsImage quality of conventional fundus imaging was superior to that of smartphone-based fundus imaging, although this novel smartphone-based fundus imaging device achieved image quality high enough to document various fundus pathologies including only subtle findings. High-quality smartphone-based fundus imaging might represent a mobile alternative for fundus documentation in clinical practice.
| S-EPMC7424474 | biostudies-literature
Project description:PurposeTo compare dilated smartphone-based imaging with a nonmydriatic, tabletop fundus camera as a teleophthalmology screening tool for diabetic retinopathy (DR).MethodsThis was a single-institutional, cross-sectional, comparative-instrument study. Fifty-six patients at a safety-net hospital underwent teleophthalmology screening for DR using standard, nonmydriatic fundus photography with a tabletop camera (Nidek NM-1000) and dilated fundus photography using a smartphone camera with lens adapter (Paxos Scope, Verana Health). Masked graders performed standardized photo grading. Quantitative comparisons were performed employing descriptive, κ, Bland-Altman, and receiver operating characteristic analyses.ResultsPosterior segment photography was of sufficient quality to grade in 89% of mydriatic smartphone-imaged eyes and in 86% of nonmydriatic tabletop camera-imaged eyes (P = .03). Using the tabletop camera as the reference to detect moderate nonproliferative DR or worse (referral-warranted DR), mydriatic smartphone-acquired photographs were found to be 82% sensitive and 96% specific. Dilated smartphone imaging detected referral-warranted DR in 3 eyes whose tabletop camera imaging did not demonstrate referral-warranted DR. Secondary masked review of medical records for the discordances in referral-warranted status from the two imaging modalities was performed, and it revealed revised sensitivity and specificity values of 95% and 98%, respectively. Overall, there was good agreement between tabletop camera and smartphone-acquired photo grades (κ = 0.91 ± 0.1, P < .001; area under the receiver operating characteristic curve = 0.99, 95% CI, 0.98-1.00).ConclusionsMydriatic smartphone-based imaging resulted in fewer ungradable photos compared to nonmydriatic table-top camera imaging and detected more patients with referral-warranted DR. Our study supports the use of mydriatic smartphone teleophthalmology as an alternative method to screen for DR.
| S-EPMC8496880 | biostudies-literature
Project description:The immature retinas of preterm neonates are susceptible to insults that disrupt neurovascular growth, leading to retinopathy of prematurity. Suppression of growth factors due to hyperoxia and loss of the maternal-fetal interaction result in an arrest of retinal vascularisation (phase 1). Subsequently, the increasingly metabolically active, yet poorly vascularised, retina becomes hypoxic, stimulating growth factor-induced vasoproliferation (phase 2), which can cause retinal detachment. In very premature infants, controlled oxygen administration reduces but does not eliminate retinopathy of prematurity. Identification and control of factors that contribute to development of retinopathy of prematurity is essential to prevent progression to severe sight-threatening disease and to limit comorbidities with which the disease shares modifiable risk factors. Strategies to prevent retinopathy of prematurity will depend on optimisation of oxygen saturation, nutrition, and normalisation of concentrations of essential factors such as insulin-like growth factor 1 and ω-3 polyunsaturated fatty acids, as well as curbing of the effects of infection and inflammation to promote normal growth and limit suppression of neurovascular development.
| S-EPMC4389630 | biostudies-literature
Project description: Not available
| S-EPMC4020289 | biostudies-literature
Project description:To describe a simple and novel technique that overcomes the limitation of smartphone-based fundus photography and allows examiners to capture peripheral retinal images with indentation. Smartphone with video camera in flash-on mode was mounted on virtual-reality (VR) headset. This was combined with +28D lens and +20D lens and soft cotton bud to capture high-quality videos of peripheral fundus with indentation. Autofocus function of the camera and examiner's head movements to adjust the distance was used to obtain retinal video. The procedure is akin to indirect ophthalmoscopy. The feasibility of obtaining well-focused retinal images during indentation was checked. We could obtain good quality videos demonstrating indentation of the peripheral fundus in 10 eyes showing different pathologies such as laser marks, lattice degeneration, and pigmented lesions. VR headset-mounted smartphone-based indentation fundus videography is an innovative cost-effective technique to capture peripheral retinal images. The technique can be useful for documenting retinopathy of prematurity lesions and other situations where widefield photography is not possible.
| S-EPMC9843566 | biostudies-literature
Project description:BackgroundThe aim of the study was to investigate the quantitative differences between severe stage 3 and stage 4A retinopathy of prematurity (ROP) by evaluating the pre-treatment fundus photographs.MethodsThirty-three eyes with clinical diagnosed as severe stage 3 were classified as severe stage 3 group. Twenty-two eyes with retinal detachment without foveal involvement were classified as stage 4A group. Quantitative measurements were performed on pre-treatment 130 degree fundus photographs.ResultsIn the severe Stage 3 group, dense fibrous membranes, vertical tractional bands, and dragging were detected in 18 eyes (55%), in 5 eyes (15%), and in none of the eyes, respectively. In the stage 4A group, dense fibrous membranes, vertical tractional bands, and dragging were detected in 21 eyes (96%), in 22(100%) eyes, and in 17 eyes (77%), respectively. Dragging and vertical tractional bands were higher in the Stage 4A group than in the severe stage 3 group (p = 0.000). Disc-to-fovea distance, the width of the fibrous membranes, the total area of the fibrous membranes, total retinoschisis, and detachment areas were significantly higher in the stage 4A group than in the severe stage 3 group (respectively, p = 0.000,p = 0.006, p = 0.024,p = 0.000).ConclusionsFibrous membranes and tractional bands can be detected in severe stage 3 ROP, but the width and the total area of the fibrous membranes and total retinoschisis-detachment area were found to be higher in stage 4A eyes. The dragging of the posterior pole can be an important diagnostic indicator for the diagnosis of stage 4A. Therefore this finding may be a simple auxiliary finding for diagnosis and prognosis of stage 4A ROP.
| S-EPMC11770912 | biostudies-literature
Project description:ImportanceArtificial intelligence (AI)-based retinopathy of prematurity (ROP) screening may improve ROP care, but its cost-effectiveness is unknown.ObjectiveTo evaluate the relative cost-effectiveness of autonomous and assistive AI-based ROP screening compared with telemedicine and ophthalmoscopic screening over a range of estimated probabilities, costs, and outcomes.Design, setting, and participantsA cost-effectiveness analysis of AI ROP screening compared with ophthalmoscopy and telemedicine via economic modeling was conducted. Decision trees created and analyzed modeled outcomes and costs of 4 possible ROP screening strategies: ophthalmoscopy, telemedicine, assistive AI with telemedicine review, and autonomous AI with only positive screen results reviewed. A theoretical cohort of infants requiring ROP screening in the United States each year was analyzed.Main outcomes and measuresScreening and treatment costs were based on Current Procedural Terminology codes and included estimated opportunity costs for physicians. Outcomes were based on the Early Treatment of ROP study, defined as timely treatment, late treatment, or correctly untreated. Incremental cost-effectiveness ratios were calculated at a willingness-to-pay threshold of $100 000. One-way and probabilistic sensitivity analyses were performed comparing AI strategies to telemedicine and ophthalmoscopy to evaluate the cost-effectiveness across a range of assumptions. In a secondary analysis, the modeling was repeated and assumed a higher sensitivity for detection of severe ROP using AI compared with ophthalmoscopy.ResultsThis theoretical cohort included 52 000 infants born 30 weeks' gestation or earlier or weighed 1500 g or less at birth. Autonomous AI was as effective and less costly than any other screening strategy. AI-based ROP screening was cost-effective up to $7 for assistive and $34 for autonomous screening compared with telemedicine and $64 and $91 compared with ophthalmoscopy in the primary analysis. In the probabilistic sensitivity analysis, autonomous AI screening was more than 60% likely to be cost-effective at all willingness-to-pay levels vs other modalities. In a second simulated cohort with 99% sensitivity for AI, the number of late treatments for ROP decreased from 265 when ROP screening was performed with ophthalmoscopy to 40 using autonomous AI.Conclusions and relevanceAI-based screening for ROP may be more cost-effective than telemedicine and ophthalmoscopy, depending on the added cost of AI and the relative performance of AI vs human examiners detecting severe ROP. As AI-based screening for ROP is commercialized, care must be given to appropriately price the technology to ensure its benefits are fully realized.
| S-EPMC8931675 | biostudies-literature
Project description: Not available
| S-EPMC5777875 | biostudies-literature