Telemedicine in Retinopathy of Prematurity: A Review of Current Evidence and Clinical Outcomes

Background/Objectives: Retinopathy of prematurity (ROP) is a leading cause of preventable childhood visual impairment, particularly in settings where access to specialized ophthalmologic care is limited. Telemedicine offers an alternative approach to ROP screening and monitoring through remote retinal imaging and expert interpretation. This narrative review aimed to evaluate the diagnostic performance, clinical benefits, implementation challenges, and future perspectives of telemedicine in ROP screening and management. Methods: A narrative literature review was conducted with consideration of the Scale for the Assessment of Narrative Review Articles (SANRA) criteria. PubMed, Scopus, and Google Scholar were searched in August and August 2026 for relevant publications from January 2000 to the search date. Two authors independently screened titles and abstracts, followed by full-text assessment according to predefined eligibility criteria. A total of 143 scientific articles and other high-quality sources were included in the final narrative synthesis. Evidence was evaluated qualitatively, without a formal risk-of-bias assessment. Findings: The reviewed literature indicates that telemedicine can expand access to ROP screening, facilitate remote specialist consultation, support longitudinal disease monitoring, and improve the triage of infants requiring urgent assessment. In selected settings, remote retinal image interpretation has demonstrated diagnostic performance comparable to conventional examinations for clinically significant and vision-threatening ROP. Artificial intelligence-based assessment and smartphone-based retinal imaging represent promising approaches to improving screening accessibility and workflow efficiency, particularly in resource-limited settings. However, implementation remains constrained by equipment costs, infrastructure limitations, image quality, workforce training requirements, and ethical and legal considerations. Conclusions: Telemedicine represents a promising complementary strategy for ROP screening and management, with the potential to improve access to timely specialist assessment and help prevent ROP-related visual impairment. Its successful integration into clinical practice requires sustainable infrastructure, standardized protocols, trained personnel, and reliable referral pathways that ensure timely in-person examination and treatment when indicated. Further research is needed to establish the effectiveness, cost-efficiency, and long-term sustainability of different telemedicine-based approaches across diverse healthcare settings.