June 26, 2014
Telemedicine Aids Early Detection of Eye Disease in Premature Infants
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A new study shows telemedicine provides an effective strategy to screen babies born prematurely for a potentially blinding disease.
Researchers at the University of Oklahoma Health Sciences Center and 13 other sites nationwide participated in the study funded by the National Eye Institute, a part of the National Institutes of Health.
“Babies born prematurely face many health risks, and one of those is the risk of retinopathy of prematurity or ROP, a debilitating eye disease that can rob a baby of vision,” said R. Michael Siatkowski, M.D., professor of pediatric ophthalmology at the OU Health Sciences Center, who cares for his young patients at The Children’s Hospital at OU Medical Center and the Dean McGee Eye Institute in Oklahoma City. Siatkowski and fellow ophthalmologist Lloyd Hildebrand led the research effort at OU.
“Telemedicine was shown in this study to provide us a new way to help even more babies, potentially easing the strain on hospitals with limited access to ophthalmologists like those in rural areas of Oklahoma and the nation,” he said.
The telemedicine approach involved training nurses in neonatal intensive care units to use a special portable camera, called a Ret-Cam, to take pictures of babies’ eyes. Those images were uploaded and sent to a distant image reading center for evaluation. Staff members at the image reading center, who were trained to recognize signs of severe retinopathy of prematurity, identified when infants should be referred to an ophthalmologist for evaluation and potential treatment. Their evaluations were compared to those of ophthalmologists. In the study, image readers correctly identified 90 percent of infants needing evaluation.
“They identified the infants at risk for progression to severe vision loss, and they did that very accurately,” said Hildebrand.
He added the individuals trained to evaluate images sent to the image reading center did not have a medical background. They were individuals selected based upon their skill at looking at something objectively and following a specific protocol.
In addition to properly identifying infants needing evaluation, 43 percent of severe cases were identified by telemedicine an average of 15 days earlier than by ophthalmic exam.
Researchers said this is important because if severe ROP is not detected and treated within a few days, it can lead to blindness.
In ROP, blood vessels in the tissue in the back of the eye called the retina begin to grow abnormally, which can lead to scarring and detachment of the retina. Some degree of ROP appears in more than half of all infants born at 30 weeks of pregnancy or younger. (A full term pregnancy is 40 weeks.) However, only 5 to 8 percent of cases become severe enough to require treatment.
Treatment usually involves either laser surgery to the developing retina or injection of a special medication into the eyeball.
“Early diagnosis and prompt treatment remains the best way to prevent vision loss in infants with ROP,” said Siatkowski.
The American Academy of Ophthalmology recommends routine screening for all babies born at gestational age 30 weeks or younger or who weigh less than 3.3 pounds at birth.
Researchers said telemedicine could save babies and their families the hardship and hazards of being unnecessarily transferred to larger facilities with greater resources and more on-site ophthalmologists.
“Research like this is very important to advance medicine, enhance the quality of care and reduce the cost of care,” Siatkowski said. “The cost to society of a blind infant is about $1 million over his or her lifetime.”
The cost of establishing a telemedicine ROP screening program includes acquisition of a special camera for taking pictures of the retina, training NICU personnel to take and transmit quality photos, and establishment and maintenance of an image reading center. Researchers believe advances in imaging and grading of images may help streamline the process even more.
“ROP is a leading cause of blindness in children, so this work addresses a major problem that is growing globally and it addresses it by standardizing care. When we standardize care, quality goes up,” Hildebrand said.
The study is reported in JAMA Ophthalmology. It was funded by grants from the National Eye Institute of the National Institutes of Health. The technical framework and software utilized for the study was created by Inoveon Corporation in Oklahoma City.