The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting.
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Date
2014-01
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Abstract
Aim: To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP)
program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously
developed tele-ROP model. Materials and Methods: KIDROP currently provides ROP screening and
treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained
to use a portable Retcam Shutt le (Clarity, USA) and validated against ROP experts performing indirect
ophthalmoscopy. An indigenously developed 20-point score (STAT score) graded their ability (Level I
to III) to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a
secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone,
Apple). Results: 6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with
94.3% of all expert decisions. The sensitivity, specifi city, positive predictive value and negative predictive
value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to
decide discharge of babies was 0.94 (P < 0.001). Only 0.4% of infants needing treatment were missed.The
kappa agreement of experts reporting on the iPhone vs Retcam for treatment requiring and mild ROP
were 0.96 and 0.94 (P < 0.001) respectively. Conclusions: This is the fi rst and largest real-world program to
employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates
that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other
middle-income countries with similar demographics.
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Keywords
Infant blindness, iPhone, middle-income countries, non-physician graders, Retcam, retinopathy of prematurity (ROP), rural areas, screening, smart phones, telemedicine, tele-ophthalmology, tele-ROP, wide-fi eld digital imaging
Citation
Vinekar Anand, Gilbert Clare, Dogra Mangat, Kurian Mathew, Shainesh Gangadharan, Shetty Bhujang, Bauer Noel. The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting. Indian Journal of Ophthalmology. 2014 Jan ; 62 (1): 41-49.