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Purpose: To investigate the characteristics of outlier infants for insights into ROP risk., Methods: Chart data were collected from 1,354 infants screened for ROP at Weill Cornell Medical Center and Columbia University Medical Center. ROP exam results and clinical risk factors were recorded. The cohort was stratified by weight, highest ROP stage, and need for ROP treatment. Descriptive and correlational statistics were performed., Results: For the overall cohort, regression analysis found that birth weight (OR: 0.741 per 100 g; 95 % CI: 0.606, 0.905), gestational age at birth (OR: 0.563 per week; 95 % CI: 0.454, 0.697), multiple gestation (OR 2.02, 95 % CI: 1.15, 3.56), bronchopulmonary dysplasia (OR: 4.68, 95 % CI: 1.93, 11.35), and necrotizing enterocolitis (OR 2.80, 95 % CI: 1.40, 5.16) were independent risk factors for treatment-requiring ROP. Black race was found to be a protective factor for treatment-requiring ROP (OR 0.244, 95 % CI: 0.095, 0.626). Among 15 infants with BW <500 g, there were no significant differences in any clinical risk factors between the 12 (80 %) with ROP vs the three (20 %) without ROP. Similarly, among infants with BW >1500 g, the 17 (9 %) with ROP only differed from the 166 (91 %) without ROP with respect to a higher incidence of necrotizing enterocolitis among those with ROP (11.8 % vs 0 %)., Conclusions: Although known clinical risk factors were predictive of ROP stage and need for laser treatment in this cohort, they were not significantly associated with ROP at extremes of birth weight. This suggests that other clinical, maternal, or genetic factors may protect from or predispose to ROP.

Background/aims: To assess accuracy of telemedical retinopathy of prematurity (ROP) diagnosis by trained non-expert graders compared with expert graders., Methods: Eye examinations (n=248) from 67 consecutive infants were captured using wide-angle retinal photography (RetCam-II, Clarity Medical Systems, Pleasanton, California, USA). Non-expert graders attended two 1-h training sessions on image-based ROP diagnosis. Using a web-based telemedicine system, 14 non-expert and three expert graders provided a diagnosis for each eye: no ROP, mild ROP, type 2 pre-threshold ROP or treatment-requiring ROP. All diagnoses were compared with a reference standard of dilated indirect ophthalmoscopy by an experienced paediatric ophthalmologist., Results: For detection of type 2 or worse ROP, the mean (range) sensitivities and specificities were 0.95 (0.94-0.97) and 0.93 (0.91-0.96) for experts, 0.87 (0.71-0.97) and 0.73 (0.39-0.95) for resident non-experts, and 0.73 (0.41-0.88) and 0.91 (0.84-0.96) for student non-experts, respectively. For detection of treatment-requiring ROP, the mean (range) sensitivities and specificities were 1.00 (1.00-1.00) and 0.93 (0.88-0.96) for experts, 0.88 (0.50-1.00) and 0.84 (0.71-0.98) for resident non-experts, and 0.82 (0.42-1.00) and 0.92 (0.83-0.97) for student non-experts, respectively., Conclusions: Mean sensitivity and specificity of trained non-experts were lower than that of experts, although several non-experts had high accuracy. Development of methods for training non-expert graders may help support telemedical ROP evaluation.

Objective: To determine the current incidence of retinopathy of prematurity (ROP) in New York state., Design: Population-based cohort study., Participants: Newborn infants (15 691) with initial hospital length of stay >28 days and date of discharge from January 1, 1996, to December 31, 2000. Subjects were identified from the New York Statewide Planning and Research Cooperative System (SPARCS) database, which contains information about every patient hospitalized in New York during this period., Methods: Demographic and clinical information about eligible infants was abstracted by searching the SPARCS database. Patients with a discharge diagnosis of ROP or who underwent laser retinal photocoagulation, scleral buckle, or pars plana vitrectomy were identified by searching for appropriate discharge and procedure codes. Incidence of ROP in the study population was determined and analyzed on the basis of birth weight., Main Outcome Measures: Incidence of any ROP, laser photocoagulation, scleral buckle, and pars plana vitrectomy in study population., Results: On the basis of SPARCS coding, the overall incidence of any ROP among all newborn infants in New York state during the study period was 0.2% (2284 of 1 167 427), or 1 in 511. The incidence of any ROP in the study population of newborns with initial hospital length of stay >28 days was 20.3% (2152 of 10 596) among infants with birth weight <1500 g and 27.3% (1839 of 6745) among infants with birth weight <1200 g. Among study patients with any ROP, the proportion who underwent laser photocoagulation during initial hospital stay was 9.5% (218 of 2284), and the proportion who underwent scleral buckle or vitrectomy surgery was 0.5% (12 of 2284). Seventeen study newborns with birth weight > or =2000 g had a discharge diagnosis of ROP, although none of these patients required laser or incisional surgery during hospitalization., Conclusions: This study involves the largest known cohort of newborns that has been analyzed for ROP. The incidence of ROP in this study is lower than results from previous multicenter clinical trials. However, the diagnosis of ROP in 17 study newborns with birth weight > or =2000 g deserves further investigation and may have implications for ROP screening protocols.