Skip to main content
SpringerLink
Log in

Diagnostic Accuracy of Pediatrician-performed Digital Retinal Imaging with 3nethra neo for ROP Screening

  • Original Article
  • Published:
Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the accuracy of pediatrician-performed wide-field digital retinal imaging (WFDRI) for diagnosing Retinopathy of prematurity (ROP), as compared to binocular indirect ophthalmoscopy (BIO) as the reference standard.

Methods

Eligible infants undergoing ROP screening were enrolled consecutively. BIO was performed by trained ophthalmologists, followed by WFDRI (using "3nethra neo" camera) by a pediatrician. An expert pediatric ophthalmologist reviewed de-identified images for quality, presence, and severity of ROP. She was masked to the findings of BIO and the pediatrician. Diagnostic accuracy for detecting any ROP, ROP requiring treatment (Type 1), and ROP requiring referral (Type 1 or 2) were calculated for WFDRI, considering BIO as the reference standard.

Results

The analysis included 427 eyes. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic accuracy, and diagnostic odds ratio of WFDRI were 0.88 (95% CI: 0.81, 0.93), 0.89 (0.85, 0.92), 7.8 (5.7, 10.9), 0.14 (0.09, 0.21), 0.89 (0.85, 0.91), and 58.3 (31, 110) respectively for detection of ‘any ROP’. For detecting ROP requiring treatment (Type 1), the sensitivity, specificity, NLR, and diagnostic accuracy were 0.90 (0.75, 0.97), 1.00 (0.99, 1.00), 0.11 (0.04, 0.27), and 0.99 (0.98, 1.00) respectively. For ROP requiring referral, the sensitivity, specificity, NLR, and diagnostic accuracy of pediatrician-performed WFDRI were 0.92 (0.80, 0.98), 1.00 (0.99, 1.00), 0.08 (0.03, 0.21), and 0.99 (0.98, 1.00) respectively. No serious adverse events were noted. The pediatrician and ophthalmologist had a near-perfect (k-1.00) and strong (k-0.88) agreement for ROP requiring treatment and any ROP, respectively.

Conclusions

Pediatrician-performed WFDRI is feasible, safe, and has excellent diagnostic accuracy for identifying ROP requiring treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fierson WM; American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018;142:e20183061.

    Article  PubMed  Google Scholar 

  2. Blencowe H, Lawn JE, Vazquez T, Fielder A, Gilbert C. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res. 2013;74:35–49.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hellström A, Smith LEH, Dammann O. Retinopathy of prematurity. Lancet. 2013;382:1445–57.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zhang R-H, Liu Y-M, Dong L, et al. Prevalence, years lived with disability, and time trends for 16 causes of blindness and vision impairment: findings highlight retinopathy of prematurity. Front Pediatr. 2022;10:735335.

    Article  PubMed  PubMed Central  Google Scholar 

  5. GBD. 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9:e130–43.

    Google Scholar 

  6. GBD. 2019 Blindness and Vision Impairment Collaborators, Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the right to sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9:e144–60.

    Google Scholar 

  7. Fierson WM, Capone A; American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, American Association of Certified Orthoptists. Telemedicine for evaluation of retinopathy of prematurity. Pediatrics. 2015;135:e238–54.

    Article  PubMed  Google Scholar 

  8. Barrero-Castillero A, Corwin BK, VanderVeen DK, Wang JC. Workforce shortage for retinopathy of prematurity care and emerging role of telehealth and artificial intelligence. Pediatr Clin North Am. 2020;67:725–33.

    Article  PubMed  Google Scholar 

  9. Vinekar A, Azad RV. The Indian Retinopathy of Prematurity (iROP) Society: challenges ahead. Indian J Ophthalmol. 2019;67:722.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Azad R, Chandra P, Gangwe A, Kumar V. Lack of screening underlies most stage-5 retinopathy of prematurity among cases presenting to a tertiary eye center in India. Indian Pediatr. 2016;53:S103–6.

    PubMed  Google Scholar 

  11. Wu C, Petersen RA, VanderVeen DK. RetCam imaging for retinopathy of prematurity screening. J AAPOS. 2006;10:107–11.

    Article  PubMed  CAS  Google Scholar 

  12. Shah PK, Narendran V, Saravanan VR, Raghuram A, Chattopadhyay A, Kashyap M. Screening for retinopathy of prematurity–a comparison between binocular indirect ophthalmoscopy and RetCam 120. Indian J Ophthalmol. 2006;54:35–8.

    Article  PubMed  Google Scholar 

  13. Roth DB, Morales D, Feuer WJ, Hess D, Johnson RA, Flynn JT. Screening for retinopathy of prematurity employing the retcam 120: sensitivity and specificity. Arch Ophthalmol. 2001;119:268–72.

    PubMed  CAS  Google Scholar 

  14. Vinekar A, Gilbert C, Dogra M, et al. 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 J Ophthalmol. 2014;62:41–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wang J, Liu C, Wu H, Ng TK, Zhang M. Diagnostic accuracy of wide-field digital retinal images in retinopathy of prematurity detection: systematic review and meta-analysis. Curr Eye Res. 2022;47:1024–33.

    Article  PubMed  CAS  Google Scholar 

  16. Chen F, Cheng D, Pan J, et al. The efficacy and safety of Retcam in detecting neonatal retinal hemorrhages. BMC Ophthalmol. 2018;18:202.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Vinekar A, Rao SV, Murthy S, et al. A novel, low-cost, wide-field, infant retinal camera, “Neo”: technical and safety report for the use on premature infants. Trans Vis Sci Tech. 2019;8:2.

    Article  Google Scholar 

  18. Vinekar A, Dogra MR, Jayadev C, Murthy S, Rao SV, Shetty B. Evaluation of a new, low-cost, portable, wide-field, digital, retinal camera, “Neo” for screening infants for retinopathy of prematurity – a prospective, multi-center, validation report in Asian Indian infants. Invest Ophthalmol Vis Sci. 2016;57:Article ID:2557805.

  19. Rashtriya Bal Swasthya Karyakram, Ministry of Health & Family Welfare, Government of India. Guidelines for Universal Eye Screening in Newborns including Retinopathy of Prematurity. 2017. Available at: https://www.nhm.gov.in/images/pdf/programmes/RBSK/Resource_Documents/Revised_ROP_Guidelines-Web_Optimized.pdf. Accessed on 30 June 2023.

  20. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol. 2005;123:991–9.

    Article  Google Scholar 

  21. Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003;121:1684–94.

    Article  Google Scholar 

  22. Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193–204.

    Article  PubMed  Google Scholar 

  23. Dhaliwal C, Wright E, Graham C, McIntosh N, Fleck BW. Wide-field digital retinal imaging versus binocular indirect ophthalmoscopy for retinopathy of prematurity screening: a two-observer prospective, randomised comparison. Br J Ophthalmol. 2009;93:355–9.

    Article  PubMed  CAS  Google Scholar 

  24. Sekeroglu MA, Hekimoglu E, Sekeroglu HT, Arslan U. Alternative methods for the screening of retinopathy of prematurity: binocular indirect ophthalmoscopy vs wide-field digital retinal imaging. Eye (Lond). 2013;27:1053–7.

    Article  PubMed  CAS  Google Scholar 

  25. Ells AL, Holmes JM, Astle WF, et al. Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study. Ophthalmology. 2003;110:2113–7.

    Article  PubMed  Google Scholar 

  26. Wongwai P, Suwannaraj S, Asawaphureekorn S. Diagnostic accuracy of a digital fundus photographic system for detection of retinopathy of prematurity requiring treatment (ROP-RT). PLoS One. 2018;13:e0201544.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wallace DK, Quinn GE, Freedman SF, Chiang MF. Agreement among pediatric ophthalmologists in diagnosing plus and pre-plus disease in retinopathy of prematurity. J AAPOS. 2008;12:352–6.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Campbell JP, Singh P, Redd TK, et al. Applications of artificial intelligence for retinopathy of prematurity screening. Pediatrics. 2021;147:e2020016618.

    Article  PubMed  Google Scholar 

  29. Gensure RH, Chiang MF, Campbell JP. Artificial intelligence for retinopathy of prematurity. Curr Opin Ophthalmol. 2020;31:312–7.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Scruggs BA, Chan RVP, Kalpathy-Cramer J, Chiang MF, Campbell JP. Artificial intelligence in retinopathy of prematurity diagnosis. Transl Vis Sci Technol. 2020;9:5.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the help of IIPHH, who donated the device to their institute.

Funding

The authors received no financial support for this study. The “3nethra neo" (Forus Healthcare, Bangalore, India) camera was donated by the Indian Institute of Public Health, Hyderabad (IIPHH). Neither IIPHH nor the camera manufacturer had any role in planning, conducting, or analyzing the study. The results have not been shared with them.

Author information

Authors and Affiliations

  1. Neonatal Unit, Advanced Pediatric Center, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Ashok Garg, Jogender Kumar, Sourabh Dutta & Praveen Kumar

  2. Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India

    Deeksha Katoch

Authors
  1. Ashok Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jogender Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deeksha Katoch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sourabh Dutta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Praveen Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AG: collected data, drafted the initial manuscript, and critically reviewed and revised the manuscript; JK and DK: conceptualized and designed the study, coordinated, and supervised data collection, analyzed data, and critically reviewed and revised the manuscript for important intellectual content; SD and PK: conceptualized and designed the study, coordinated, and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work. PK will act as guarantor for the manuscript.

Corresponding author

Correspondence to Jogender Kumar.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garg, A., Kumar, J., Katoch, D. et al. Diagnostic Accuracy of Pediatrician-performed Digital Retinal Imaging with 3nethra neo for ROP Screening. Indian J Pediatr (2024). https://doi.org/10.1007/s12098-024-05042-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12098-024-05042-z

Keywords

Search

Navigation