Eyecare-Cloud enabling 21 years of real world pediatric ophthalmology practice and paperless healthcare

Global child health initiatives increasingly recognize the importance of eye care, with retinopathy of prematurity (ROP) remaining the leading preventable cause of childhood blindness. We introduce Eyecare-Cloud, a WeChat-integrated digital platform that unifies clinical workflows, telemedicine, and research to enhance pediatric eye care, with movie presentations illustrating its real-world implementation. In this retrospective study with prospective follow-up from 2004 to 2024, data from 47,372 infants across 32 provinces in China were analyzed to evaluate 21-year trends in ROP incidence, associated risk factors, diagnostic thresholds, and cost-effectiveness. Among 26,258 preterm infants, the incidence was 17.83% (95% CI, 17.37–18.29%) for any ROP and 5.74% (95% CI, 5.46–6.02%) for treatment-requiring ROP (TR-ROP), with both rates showing a steady decline and stabilization over time. Lower gestational age (GA), lower birth weight (BW), male gender, and vaginal delivery were significantly associated with ROP and TR-ROP (all p < 0.001). Receiver operating characteristic (ROC) analysis identified optimal thresholds for predicting TR-ROP as GA < 31.5 weeks (sensitivity 90.5%, specificity 54.4%), BW < 1598 g (90.0%, 46.8%), and GA < 31.5 weeks or BW < 1598 g (95.5%, 38.3%). Over the past decade, Eyecare-Cloud has achieved an estimated USD 925,608 in patient cost savings. By integrating real-world data, telemedicine, and clinical decision support, Eyecare-Cloud establishes a scalable digital health infrastructure for pediatric eye care, reducing healthcare costs and offering a replicable model for preventing childhood blindness globally.