A new study has determined that telemedicine can be used successfully to identify newborn infants who need specialized medical treatment for retinopathy or prematurity (ROP), a leading cause of treatable blindness.
The study, conducted at 13 neonatal intensive care units in the United States and Canada and recently published in JAMA Ophthalmology, found that trained non-physician evaluators at a remote reading center could identify newborns at risk of acquiring ROP by studying retinal images transmitted to their computer screens.
"This study provides validation for a telemedicine approach to ROP screening and could help prevent thousands of kids from going blind," Graham E. Quinn, MD, MSCE, a pediatric ophthalmologist at The Children's Hospital of Philadelphia and lead investigator for the study, said in a recent press release. "Telemedicine potentially gives every hospital access to excellent ROP screening."
The study holds promise for smaller or rural hospitals that don't have on-site ophthalmologists, as well as infant care programs in developing countries. It also points to the value of centralized telemedicine centers that could handle image viewing duties for a number of outlying healthcare providers and ease clinician workflows.
ROP, or the abnormal growth of blood vessels in the retina, occurs in more than half of all infants born at 30 weeks of gestation or earlier, but is severe enough to warrant treatment in roughly 5 percent to 8 percent of the cases. The American Academy of Ophthalmology recommends routine screening for all infants born at or before 30 weeks of gestation or weighing less than 3.3 pounds.
Quinn, a professor of Ophthalmology in the Perelman School of Medicine at the University of Pennsylvania, coordinated the ROP study conducted by the e-ROP Cooperative Group, a collaboration of 13 neonatal intensive care units, 12 in the United States and one in Canada, and funded by the National Eye Institute, part of the National Institutes for Health. The study focused on 1,257 premature infants.
According to officials, all of the infants received regularly scheduled diagnostic examinations by an on-site ophthalmologist, who determined if they needed further evaluation. In the meantime, NICU staff members took retinal photographs of the infants and sent them to the University of Pennsylvania, where the photos were examined by non-physician image readers. Those readers were not told that the infants had already been examined for ROP by ophthalmologists.
According to the study, the image readers and the ophthalmologists agreed on almost every infant who needed further ROP testing. Of the 244 babies identified by the ophthalmologists, 162 subsequently received treatment, and 159 of them were identified by the image readers as needing further review.
According to Quinn, telemedicine actually has an advantage over on-site screening. Non-physician image readers can view more retinal images than ophthalmologists, they can establish a more standardized approach to ROP screening, and using the readers would reduce the costs of routine ROP screening while freeing up the ophthalmologists' time for other duties. In addition, he said, remote screening would decrease the number of infants transferred to larger hospitals that have on-site ophthalmologists.
To watch a video on the e-ROP study, click here.