Retinopathy of Prematurity Screening

What it does

Retinopathy of Prematurity Screening reads the wide-field retinal image sets taken of premature infants with contact neonatal cameras: several fields per eye covering the posterior pole and the periphery. The images, the readers, the grading system and the follow-up intervals all differ from adult fundus screening, so this exam has its own model.

For each eye the run checks whether the image set is acceptable for ROP grading, classifies the posterior-pole vessels as normal, pre-plus or plus disease, and reads the retina against the third edition of the International Classification of Retinopathy of Prematurity: the zone (I–III) of the most posterior disease, the highest stage (1–5), aggressive ROP, and whether the findings meet treatment-warranted ROP, with the recommended re-examination interval.

Intended use

Decision support for ROP screening, especially tele-screening, where trained nurses or non-specialists capture the images and paediatric ophthalmologists are scarce. A missed treatment-warranted eye can lead to blindness, so the result states plainly when an image set is not good enough to rule it out.

Who it is for

Paediatric ophthalmologists and retina specialists, neonatal intensive care teams, ROP screening nurses and tele-screening networks. Developers integrate the run into neonatal camera software and tele-ophthalmology platforms.

Accepted input

• DICOM: Wide Field Ophthalmic Photography and Ophthalmic Photography objects from contact wide-field neonatal cameras.
• Image files: JPEG, PNG or TIFF exports from the camera software.
• One study is both eyes of one examination, with several fields per eye.

Requirements

Requirement	Why
Posterior-pole image centred on the disc	Plus disease is judged on the posterior-pole vessels
Peripheral fields around the posterior pole	Zone and stage need the vascularised border in the periphery
Laterality on every image (tag or detected)	Each eye gets its own zone, stage and treatment flag
Field of view known from the device	Zone boundaries are defined by distance from the disc and fovea

Poor image quality and missing peripheral fields are the most common limits in ROP imaging. The quality section names what is missing per eye rather than grading a partial set.

Optional context

Gestational age at birth, birth weight, postmenstrual age at examination, previous ROP examinations and prior treatment go in clinical_context; they place the findings in the screening schedule.

The result

Section	Content
Image quality	Per image and per eye: acceptable for ROP grading or not, with the reason
Plus disease	Normal, pre-plus or plus disease per eye from the posterior-pole image
ICROP3 zone and stage	Zone I–III, stage 1–5, aggressive ROP (A-ROP), treatment-warranted ROP and re-examination interval
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• Classification: ICROP3 (2021), the International Classification of Retinopathy of Prematurity, third edition, for plus disease, zone, stage and A-ROP.
• DICOM: SR TID 1500 with ophthalmic measurement groups, KOS key images and Encapsulated PDF.
• Coding: SNOMED CT and ICD-10/ICD-11 with explicit laterality (OD/OS).

Reading the result

Agreement between examiners is low for pre-plus disease. The plus grade is returned with the posterior-pole image it was read on, for comparison with the standard photographs used in the screening programme.