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

Anand Vinekar*, Clare Gilbert, Mangat Dogra, Mathew Kurian, Gangadharan Shainesh, Bhujang Shetty, Noel Bauer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Aim: To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously developed tele-ROP model. Materials and Methods: KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained to use a portable Retcam Shutt le (Clarity, USA) and validated against ROP experts performing indirect ophthalmoscopy. An indigenously developed 20-point score (STAT score) graded their ability (Level I to III) to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone, Apple). Results: 6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with 94.3% of all expert decisions. The sensitivity, specificity, positive predictive value and negative predictive value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to decide discharge of babies was 0.94 (P <0.001). Only 0.4% of infants needing treatment were missed. The kappa agreement of experts reporting on the iPhone vs Retcam for treatment requiring and mild ROP were 0.96 and 0.94 (P <0.001) respectively. Conclusions: This is the first and largest real-world program to employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other middle-income countries with similar demographics.
Original languageEnglish
Pages (from-to)41-49
JournalIndian Journal of Ophthalmology
Issue number1
Publication statusPublished - Jan 2014


  • Infant blindness
  • iPhone
  • middle-income countries
  • non-physician graders
  • Retcam
  • retinopathy of prematurity (ROP)
  • rural areas
  • screening
  • smart phones
  • telemedicine
  • tele-ophthalmology
  • tele-ROP
  • wide-field digital imaging

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