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This review aimed to review the information and communications technology available for telemedicine, the internet access and economic status of countries at greater risk for higher prevalence of ROP, the framework of established ROP telemedicine programmes, and the cost-effectiveness of telemedicine. They describe the first wave of ROP epidemic in the 1940s related to uncontrolled use of supplemental oxygen in neonates, the second epidemic in the 1970/80s due to increased survival of low birth weight infants and the third epidemic in middle income countries in which NICUs are now being developed and associated with factors such as higher birth rates and increased survival rates. Challenges relate to adverse legal climate, insurance costs, ROP classification variance and lack of appropriate trained ophthalmologists. They report growth in internet access with spread across middle income countries, and differences in connection speeds between urban and rural areas. Spread of wireless internet technology is needed to promote internet access in low-income countries. This can be enhanced by two potential solutions. 1, Wi-Fi which can be mass produced at low cost and shown to be successfully implemented. 2, CDMA4.50 – a cellular technology that lowers band frequency, obtains a larger coverage base and lowers costs. There is potential to use delay tolerant networks (DTNs) to communicate information in pulses rather than constantly. This potentially mitigates for power outages in low-income countries. They also considered wired communication such as ISDN to transmit via cables which is particularly useful in underserved regions. Various telemedicine systems for ROP are available with retinal imaging by non-physicians as an alternative to ophthalmoscopy assessment, with image review remotely by ophthalmologists. Costs include equipment, training ICT, examinations, transfer, treatment and admission fees. There is limited cost analysis data in the literature. Whilst telemedicine has a strong history in high-income countries, issues persists for low-income countries with funding required for ICT infrastructure, the latter more likely to be funded by the private sector rather than government which consequently impacts sustainability.

Addressing the third epidemic of ROP through telemedicine and technology: a systematic review.
Al-Khaled T, Valikodath NG, Patel SN, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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