Update: Since I originally posted this blog, I have learned that the activity is open and available to all as part of the Pediatric Ophthalmology Education Center on the ONE Network; AAO membership is not required to access these cases. You can use the simulator directly by visiting https://www.aao.org/pediatric-center-detail/retinopathy-of-prematurity-case-based-training.
Retinopathy of prematurity remains one of the most challenging conditions to both diagnose and treat. The fundus examination is often suboptimal due to incomplete mydriasis or opacities in the vitreous body while small details in the retina may mean the difference between choosing to treat rather than to observe. The patients are often unstable, thereby reducing the time allowed for training, and an inexperienced examiner may miss crucial clues, leading to unnecessary loss of vision. Taking all these factors into account, it is easy to understand how ROP may seem like a formidable challenge for an ophthalmologist entering the field.
A little over a year ago, the American Academy of Ophthalmology released a simulator for helping doctors in this initial phase. It is called Retinopathy of Prematurity: Case-Based Training, and it is available on the educational part of the AAO website, called the ONE Network.
I highly recommend beginning with reading the ROP tutorial, found on the lower right-hand side in the simulator, to refresh your knowledge of the disease before going ahead with the training. The simulator contains 20 patients (40 eyes), and you are given brief details about birth weight, postmenstrual age and gestational age along with photos of the anterior chamber and the retina. You are then to decide which zones are affected and to what extent and if there is presence of plus disease, and finally categorize the condition and come up with a treatment plan. After submitting your answers, you will receive instant feedback for each case, showing your grade and where you have made mistakes. After completing all 20 cases, you will receive a final grade.
I have found this tool incredibly useful, and it is like the missing link between theory and practice. It initially contained only 10 cases, but it has now introduced an additional 10 cases, and I sincerely hope it will add more in the future. The user interface is intuitive and pleasant to use. The simulator does not replace the experience that comes with examining real patients, but it is a great warmup so that when faced with a real patient you are more efficient and more aware of what to look for.
Helgi David Björnsson, MD, runs a website with a collection of his favorite finds on Ophtholinks.com. He can be reached at email: firstname.lastname@example.org.