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Retinopathy of prematurity (ROP) is a disease that affects retinal vasculature in premature infants and remains one of the leading causes of blindness in childhood worldwide. ROP screening can encounter some difficulties such as the lack of specialists and services in rural areas. The evolution of technology has helped address these issues and led to the emergence of state-of-the-art multimodal digital imaging devices such fundus cameras with its variable properties, optical coherence tomography (OCT), OCT angiography, and fluorescein angiography which has helped immensely in the process of improving ROP care and understanding the disease pathophysiology. Computer-based imaging analysis and deep learning have recently been demonstrating promising outcomes in regard to ROP diagnosis. Telemedicine is considered an acceptable alternative to clinical examination when optimal circumstances for ROP screening in certain areas are lacking, and the expansion of these programs has been reported. Tele-education programs in ROP have the potential to improve the quality of training to physicians to optimize ROP care., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Middle East African Journal of Ophthalmology.)

The rising prevalence of retinopathy of prematurity (ROP) in low- and middle-income countries has increased the need for screening at-risk infants. The purpose of this article was to review the impact of tele-medicine and technology on ROP screening programs. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was performed using PubMed, Pro-Quest, and Google Scholar bibliographic search engine. Terms searched included retinopathy of prematurity, telemedicine, and tele-ophthalmology. Data regarding internet access and gross domestic product per capita were obtained from the World Bank. Information was also obtained about internet access, speeds, and costs in low-income countries. There has been increasing integration of telemedicine and technology for ROP screening and management. Low-income countries are using available internet options and information and communications technology for ROP screening, which can aid in addressing the unique challenges faced by low-income countries. This provides a promising solution to the third epidemic of ROP by expanding and improving screening and management. Although telemedicine systems may serve as a cost-effective approach to facilitate delivery of health care, programs (especially in lowand middle-income countries) require national support to maintain its infrastructure. [ J Pediatr Ophthalmol Strabismus . 2021;58(4):261-269.] .

It is technically difficult to construct wide-angle fundus imaging devices due to the complexity of conventional transpupillary illumination and imaging mechanisms. We report here a new method, i.e., trans-palpebral illumination, for wide-angle fundus photography without the need for pupil dilation. By constructing a smartphone-based prototype imaging device, we demonstrated a 152° view in a single-shot image. The unique combination of low-cost smartphone design and automatic illumination optimization promises an affordable solution to conduct telemedicine assessment of eye diseases, which will improve access to eye care for patients in rural and underserved areas.