Telemedicine can be used to screen for the potentially blinding disease known as retinopathy of prematurity (ROP), according to a study from the National Eye Institute (NEI).
For the study, doctors used telemedicine to screen for ROP, electronically sending photos of babies’ eyes to a distant image reading center for evaluation. Premature infants are at risk for ROP, often those who are born at 30 weeks or earlier. The disease must be diagnosed and treated early to prevent vision loss, the American Academy of Ophthalmology recommends routine screening for all babies who are born at gestational age 30 weeks or younger or who weigh less than 3.3 pounds at birth. However, many under-served hospitals, the researchers of the study note, do not have access to ophthalmologists.
The researchers used telemedicine for 1,257 premature infants, typically on average 13 weeks early. Each infant underwent a screening by a ophthalmologist, who was looking to see if a referral for treatment was necessary. Those who were referred were designated as having referral-warranted ROP (RW-ROP).
They then took trained non-physician image readers at the University of Pennsylvania, Philadelphia and compared them to the on-site ophthalmologists. A non-physician staff member in the neonatal intensive care unit (NICU) took photos of the infant’s retinas and uploaded them to a secure server at the University of Oklahoma, Oklahoma City. They were sent to the image readers at the University of Pennsylvania, who were asked to report the presence or absence of RW-ROP.
The remote image readers were right up to 90 percent of the time, correctly identifying the had RW-ROP based on examination by an ophthalmologist (244 off the 1,257). They were accurate on 87 percent of the images where the infants lacked RW-ROP.
“This is the first large clinical investigation of telemedicine to test the ability of non-physicians to recognize ROP at high risk of causing vision loss,” Eleanor Schron, Ph.D., group leader of NEI Clinical Applications, said in a statement. “The results suggest that telemedicine could improve detection and treatment of ROP for millions of at-risk babies worldwide who lack immediate in-person access to an ophthalmologist,” she said.
The researchers say that telemedicine has advantages over in-person screenings. For one, it can be done more frequently.
"It’s much easier to examine the retina when not dealing with a wiggling baby,” Graham E. Quinn, M.D., professor of ophthalmology at the Children's Hospital of Philadelphia and the lead investigator for the study, said in a statement. “If a baby is too fussy or otherwise unavailable when the ophthalmologist visits the NICU, the exam may be delayed until the ophthalmologist returns — sometimes up to a week later.”
The researchers say that weekly ROP screenings via telemedicine are a realistic goal. They say it could also save time. In the study, 43 percent of advanced ROP cases were identified by telemedicine before they were detected by an ophthalmologist. It also may save money, they note, since it could reduce the demands of ophthalmologists.