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   Table of Contents      
LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 178-179

Response to comment on “Impact of expansion of telemedicine screening for retinopathy of prematurity in India”


1 Departments of Pediatric Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
2 Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
3 Department of Ophthalmology, London School of Hygiene and Tropical Medicine, London, UK
4 Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication28-Dec-2017

Correspondence Address:
Anand Vinekar
Department of Pediatric Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_832_17

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How to cite this article:
Vinekar A, Mangalesh S, Jayadev C, Gilbert C, Dogra M, Shetty B. Response to comment on “Impact of expansion of telemedicine screening for retinopathy of prematurity in India”. Indian J Ophthalmol 2018;66:178-9

How to cite this URL:
Vinekar A, Mangalesh S, Jayadev C, Gilbert C, Dogra M, Shetty B. Response to comment on “Impact of expansion of telemedicine screening for retinopathy of prematurity in India”. Indian J Ophthalmol [serial online] 2018 [cited 2019 Sep 22];66:178-9. Available from: http://www.ijo.in/text.asp?2018/66/1/178/221822



We thank the authors query on our article.[1],[2] Our aim was to impress upon our readers the impact of expansion of our current tele-retinopathy of prematurity (ROP) model in Karnataka, to other states where ROP either already is, or expected to become, a major public health problem.

However, as is evident, these are mere estimations. The only true index we have for this estimation is the ongoing KIDROP dataset, pooled from previous publications [3],[4],[5] and our experience, which has been used in the manuscript.[2]

By estimating “survivors” we must suppose that this is the minimum number who will be admitted to the neonatal units after discounting for infant mortality.[2] In reality, early neonatal mortality rates should have been used. However, reliable figures are unavailable at this time. Furthermore, we first estimated the number who “could be” <2000 g at birth, and then calculated the incidence of “any stage” and “treatment requiring” ROP from this “guesstimate.”[2]

If these were underestimating the problem as suggested, then in Karnataka, of the 14,153 babies who would survive, approximately 500 infants would require treatment annually, if we use 3.5% as suggested by the author. In the real world experience from KIDROP, we treat 210–250 babies in a year, which is approximately 7% of those with any stage ROP (3169 infants). This measure is closer to our previously published incidence [3] and this is why we chose to use this method in the manuscript.[2] Hence, an underestimation as suggested by the author is unlikely.

Only real data from state wide ROP screening operations from these suggested states in the future will decide how local conditions impact variation in disease incidence. Until then, one estimate is as good as another.

Acknowledgment

The authors would like to acknowledge KIDROP team members, Praveen Sharma, Sivakumar Munusamy, Krishnan AN, Muralidhar Gayakwad, Ravishankar Kandagal, Madhava Padaki and Someshwar Matad for their participation and support in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Agarwal TL, Aditya K, Agrawal N. Joshi I. Comment on “Impact of expansion of telemedicine screening for retinopathy of prematurity in India”. Indian J Ophthalmol 2018;66:177-8.  Back to cited text no. 1
  [Full text]  
2.
Vinekar A, Mangalesh S, Jayadev C, Gilbert C, Dogra M, Shetty B, et al. Impact of expansion of telemedicine screening for retinopathy of prematurity in India. Indian J Ophthalmol 2017;65:390-5.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Vinekar A, Jayadev C, Mangalesh S, Shetty B, Vidyasagar D. Role of tele-medicine in retinopathy of prematurity screening in rural outreach centers in India – A report of 20,214 imaging sessions in the KIDROP program. Semin Fetal Neonatal Med 2015;20:335-45.  Back to cited text no. 3
[PUBMED]    
4.
Hungi B, Vinekar A, Datti N, Kariyappa P, Braganza S, Chinnaiah S, et al. Retinopathy of prematurity in a rural neonatal Intensive Care Unit in South India – A prospective study. Indian J Pediatr 2012;79:911-5.  Back to cited text no. 4
[PUBMED]    
5.
Vinekar A, Avadhani K, Dogra M, Sharma P, Gilbert C, Braganza S, et al. A novel, low-cost method of enrolling infants at risk for retinopathy of prematurity in centers with no screening program: The REDROP study. Ophthalmic Epidemiol 2012;19:317-21.  Back to cited text no. 5
[PUBMED]    




 

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