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Telemedicine initiative identified treatable cases of retinopathy of prematurity
Acta Ophthalmol. 2009;doi:10.1111/j.1755-3768.2009.01715.x.
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A telemedicine initiative effectively identified all cases of treatment-warranted retinopathy of prematurity, according to a study.
Investigators reported 24-month results from the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) initiative.
"The SUNDROP telemedicine screening initiative for ROP has been proven to have a high degree of sensitivity and specificity for the identification of treatment-warranted disease," the study authors said. "All cases of treatment-warranted disease were captured. There were no adverse outcomes."
The retrospective analysis included 320 eyes of 160 infants screened for ROP with the Retcam II (Clarity Medical Systems). Five or six images of each eye, or 7,556 total images, were obtained during 669 exams.
All patients underwent a dilated ocular examination within 1 week after discharge. Primary outcome measures included treatment-warranted ROP and anatomic outcomes.
Study data showed that the initiative caught all cases of treatment-warranted ROP during the 24-month period. The system identified seven infants with treatment-warranted ROP; six infants underwent laser photocoagulation and one experienced spontaneous regression.
"The sensitivity was 100%, with specificity of 99.4%," the authors said. "No patient progressed to retinal detachment or other adverse outcomes."
The take-home message of this study is that it may be possible for health care professionals other than ophthalmologists to screen for retinopathy of prematurity in the NICU setting. A prerequisite is that the screeners be very well trained in diagnostic and interpretative ophthalmic imaging and have ophthalmologic support. Physician manpower requirements might be lessened using a device such as the RetCam II, but issues such as the length of time it takes to obtain useful images, potential corneal trauma and the infant’s duress during the process must be considered. Individual variability of image interpretation in the staging of ROP has been found to be a problem in some previous studies.
– Rudolph S. Wagner, MD
OSN
Pediatrics/Strabismus Board Member