Introduction

We are currently in the “third epidemic” of retinopathy of prematurity (ROP) because many recently developed neonatal intensive care units in middle-income countries are treating more infants with advanced disease. In addition, the International Classification of Retinopathy of Prematurity (ICROP3) Committee is currently working on the reclassification of this disease. This has been prompted by the need for standardization globally and to address changes in the pathophysiology brought about by anti-vascular endothelial growth factor therapy. For example, reactivation of ROP requires a definition and description because it did not exist until recently. Advances in imaging and telemedicine are occurring rapidly.

In this issue, Al-Khaled et al describe why there is a third epidemic and explore in depth how telemedicine is extremely useful in the management of ROP. They point out that the availability of internet communications technology and internet access varies with the economic status of a particular country and describe how this affects the treatment given. In addition, they reference successful working models of telemedicine programs, including the Stanford University Network for Diagnosis of Retinopathy of Prematurity. This network demonstrates the efficacy of retinal imaging by non-physicians as an alternative to binocular indirect ophthalmoscopy. An example of how this has been successfully adopted is a screening program under the guidance of pediatric ophthalmologists in rural Montana.

The treatment of ROP is indeed a global issue and telemedicine is a viable option in many remote locations. Unfortunately, the countries that would most benefit from internet communications technology often lack the resources to develop quality telemedicine screening and treatment programs. Certainly, an international consensus in establishing diagnostic criteria as we will soon have from the ICROP3 Committee will help. However, it is apparent that funding for telehealth programs comes largely from the private sector, and the government is the main source of funding for only 22% of telehealth programs. Al-Khaled et al believe that this poses a problem because these programs become reliant on donors, which may inhibit government funding and therefore self-sustainability.

Technologically speaking, the world is becoming smaller but access to this sight-saving technology remains limited. Information as presented in the article by Al-Khaled et al brings attention and possibly solutions to this growing problem.

Rudolph S. Wagner, MD

Editor

中文翻译：

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抗击早产儿视网膜病的第三次流行病

介绍

我们目前正处于早产儿视网膜病变 (ROP) 的“第三次流行病”中，因为中等收入国家最近开发的许多新生儿重症监护病房正在治疗更多患有晚期疾病的婴儿。此外，国际早产儿视网膜病变分类（ICROP3）委员会目前正在对该疾病进行重新分类。这是由全球标准化的需要和解决抗血管内皮生长因子治疗带来的病理生理学变化所促成的。例如，ROP 的重新激活需要一个定义和描述，因为它直到最近才存在。成像和远程医疗的进步正在迅速发生。

在本期中，Al-Khaled 等人描述了为什么会出现第三次流行病，并深入探讨了远程医疗在 ROP 管理中的作用。他们指出，互联网通信技术和互联网接入的可用性随特定国家的经济状况而变化，并描述了这如何影响所给予的治疗。此外，他们还参考了远程医疗项目的成功工作模式，包括斯坦福大学早产儿视网膜病变诊断网络。该网络证明了非医生进行视网膜成像作为双目间接检眼镜的替代方案的功效。如何成功采用这种方法的一个例子是在蒙大拿州农村的儿科眼科医生指导下的筛查计划。

ROP 的治疗确实是一个全球性问题，远程医疗在许多偏远地区是一个可行的选择。不幸的是，最能从互联网通信技术中受益的国家往往缺乏资源来开发高质量的远程医疗筛查和治疗计划。当然，ICROP3 委员会很快将在建立诊断标准方面达成国际共识，这将有所帮助。然而，远程医疗项目的资金显然主要来自私营部门，而政府是仅 22% 的远程医疗项目的主要资金来源。Al-Khaled 等人认为，这会带来问题，因为这些项目依赖于捐助者，这可能会抑制政府资助，从而抑制自我可持续性。

从技术上讲，世界正在变得越来越小，但这种视力保护技术的使用仍然有限。Al-Khaled 等人在文章中提供的信息引起了人们对这一日益严重的问题的关注并可能提供了解决方案。

Rudolph S. Wagner，医学博士

编辑