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Comment & Response
March 2015

Need for Telemedicine in Retinopathy of Prematurity in Middle-Income Countriese-ROP vs KIDROP

Author Affiliations
  • 1Department of Pediatric Retina, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
  • 2Faculty of Ophthalmology, Maastricht University, Maastricht, the Netherlands

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Ophthalmol. 2015;133(3):360-361. doi:10.1001/jamaophthalmol.2014.4913

To the Editor We appreciate the results of the e-ROP Study evaluating telemedicine to detect severe (referral-warranted) retinopathy of prematurity (ROP).1

The KIDROP program ( in rural India has employed trained nonphysicians to perform retinal imaging and report findings using an indigenous, International Classification of Retinopathy of Prematurity–based triage algorithm into red (treatment), orange (follow-up), and green (fit for discharge).2 Technicians are graded into 3 skill-based levels, taking up to 90 days (>2000 images) for training. Technicians capturing images, especially of the retinal periphery, can self-report using the dynamic video session for evaluation of the retina. From 51 322 imaging sessions in 81 centers, we found sensitivity, specificity, positive predictive value, and negative predictive value for treatment-requiring disease of 95.7%, 93.2%, 81.5%, and 98.6%, respectively. The e-ROP Study found a higher sensitivity and specificity in their nonphysicians compared with their expert ophthalmologists.1 Technicians in our method missed 0.9% of infants needing treatment.2

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