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NICUs slow to embrace telemedicine for ROP screening
In a survey, 55% of NICU directors said they were neutral on whether or not it is safe to use telemedicine to screen for ROP.
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Many neonatal intensive care units have difficulty enlisting ophthalmologists to screen for retinopathy of prematurity, but most are not yet convinced telemedicine can help fill the void, according to a study.
Even so, the authors of the survey on trends in ROP treatment believe the use of retinal imaging in telemedicine will eventually become the primary means of screening premature infants for the condition.
“This survey validates concerns about an evolving ROP workforce and whether there will be sufficient providers to screen and treat infants affected by ROP, especially in their original NICU,” Rebecca J. Vartanian, MD, the study’s lead author and a neonatologist at C.S. Mott Children’s Hospital in Ann Arbor, Michigan, told Ocular Surgery News.
“Overall, we feel that there is an opportunity to address this proactively and develop safe, convenient and family-centered practices to ensure infants are receiving the best ROP care possible,” she said.
The study, published in Pediatrics, included an analysis of survey responses from the directors of 379 level III and IV NICUs in 47 U.S. states in September 2015.
Altogether, 56% of respondents said their areas had enough ophthalmologists to screen for or treat ROP; 20% reported having difficulty maintaining ophthalmologic services for ROP in the previous 2 years.
Turning to telemedicine
Given the implications for thorough evaluation of premature infants for the condition, some NICUs have turned to telemedicine via retinal imaging devices as either a primary or adjunct screening method. Patients whose images warrant further ophthalmologic care are referred accordingly.
While noting that the approach has been used to some degree over the past 15 years, Vartanian and colleagues found that 55% of survey respondents were neutral on whether the use of telemedicine for ROP screening is safe. Another 30% said it is safe, while 15% felt that it is not safe.
Retinal imaging devices were used for primary screening in 26 NICUs (7%) surveyed and as an adjunct to examination in 51 NICUs (14%).
Contrary to the low acceptance rate for telemedicine, the authors noted a 2014 study in which Quinn and colleagues found telemedicine to be a valid screening approach. In that study, non-physician staff who were trained in wide-field digital photography relayed infant retinal images to readers, also non-physicians. The readings yielded 90% sensitivity and 87% specificity.
Screening via imaging on the rise
Although increasing the number of well-trained eye care providers to screen and care for ROP would be ideal, Vartanian and colleagues feel that screening via retinal imaging will become more popular.
“We anticipate a slow but steady increase in the number of centers using retinal imaging as the primary method of screening due to multiple factors, including a decline in the number of ophthalmologists providing ROP screening services, decreasing number of new graduates of ophthalmology residency programs trained or interested in providing ROP care, and increasing acceptance of imaging as a suitable technology to embrace for ROP screening,” study co-author Cagri G. Besirli, MD, PhD, said.
“The percentage of NICUs using retinal imaging as an adjunct to bedside examination will likely remain the same as the high cost of imaging technology and low reimbursement rate for image acquisition and interpretation are prohibitive, especially in the absence of an institutional need to replace bedside examination with a telemedicine program,” he said.
OSN Pediatrics/Strabismus Section Editor Robert S. Gold, MD, said telemedicine can be a valuable tool, but one with limits.
“Telemedicine can be a very important adjunct to the screening of ROP in areas that are not served by pediatric ophthalmologists or retina specialists,” Gold said. “There are some areas of the country that have issues with finding ophthalmologists to screen and treat these babies.”
In his practice, Gold said, telemedicine’s adjunct role involves following and documenting infants who may need treatment for ROP.
Whatever the specifics, however, he stressed that telemedicine will not disappear from NICUs.
“It is something that is here,” he said. “It is here to stay. I don’t ever see it replacing ophthalmologists in large NICUs because it takes so long to do. If we screen 20 to 25 babies in a week — and that would be a lot — it will take one person hours to take these RetCam photos.”
Gold added that effective retinal imaging is challenging to staff who undertake it.
“Many people who are taking these photographs are very uncomfortable with it,” he said. “It requires a lot of training.” – by Joe Green
- References:
- Quinn GE, et al. JAMA Ophthalmol. 2014;doi:10.1001/jamaophthalmol.2014.1604.
- Vartanian RJ, et al. Pediatrics. 2016;doi:10.1542/peds.2016-1978.
- For more information:
- Cagri G. Besirli, MD, PhD, can be reached at Department of Ophthalmology and Visual Sciences, University of Michigan, Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48105; email: cbesirli@med.umich.edu.
- Robert S. Gold, MD, can be reached at 790 Concourse Parkway South, Suite 200, Maitland, FL 32751; email: rsgeye@gmail.com.
- Rebecca J. Vartanian, MD, can be reached at C.S. Mott Children’s Hospital, 1540 East Medical Center Drive, Ann Arbor, MI 48109; email: rebeccav@med.umich.edu.
Disclosures: Besirli, Gold and Vartanian report no relevant financial disclosures.