NIH’s National Eye Institute (NEI) reports that a study has determined that telemedicine is an effective strategy to screen for the potentially blinding disease known as Retinopathy of Prematurity (ROP). The study reported in JAMA Ophthalmology was conducted by the e-ROP Cooperative Group, a collaboration that includes 13 clinical sites and resource centers in the U.S and Canada.
This approach if adopted broadly could help ease the strain on hospitals with limited access to ophthalmologists and lead to better care for infants in underserved areas of the country. The telemedicine strategy consists of electronically sending photos of babies’ eyes to a distant image reading center for evaluation.
Staff at the image reading center trained to recognize signs of severe ROP are able to identify infants that should be referred to an ophthalmologist for evaluation and potential treatment. The study tested how accurately the telemedicine approach reproduced the conclusions of ophthalmologists who examined the babies’ onsite.
The study evaluated telemedicine used for ROP screening during the usual care of 1,257 premature infants who were born on average 13 weeks early. About every nine days, each infant underwent screening by an ophthalmologist who assessed whether referral for treatment was warranted. The babies that were referred were designated as Referral-Warranted ROP (RW-ROP).
Either immediately before or after the exam, a non-physician staff member in the NICU took images of the infant’s retinas and uploaded them to a secure server at the University of Oklahoma. Trained non-physician image readers at the University of Pennsylvania then downloaded the photos independently, evaluated them following a standard protocol, and reported the presence or absence of RW-ROP.
By using the telemedicine approach, non-physician image readers correctly identified 90 percent of the infants thought to have RW-ROP based on examinations by an ophthalmologist. They were correct 87 percent of the time when presented with images from infants who did not have RW-ROP.
The examining ophthalmologists documented 244 infants with RW-ROP on exam and after referral, 162 infants were treated. Of these infants, non-physician image readers identified RW-ROP in all but three infants.
Advantages to using telemedicine for screening are that babies are not unnecessarily transferred to larger hospital nurseries with more resources and more on-site ophthalmologists. Also, telemedicine may bring down the costs of doing routine ROP screening by reducing the demands on ophthalmologists whose time is better allocated to other babies who need their attention and expertise.
For more information, go to www.nei.nih.gov/health/rop/>/. To view a video about e-ROP, go to http://youtu.be/71_CqiV3NMA>.