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Nasrin N. Tehrani; Telemedicine Screening for Retinopathy of Prematurity (ROP): Three years experience in Ontario, Canada. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5881.
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We investigated clinical outcomes of a Telemedicine ROP Screening Program between two Neonatal Intensive Care Units (NICU), a level II NICU and a modified level III NICU and a central reading site, using real-time 2 way audio-video connection.
Neonatology personnel at the two remote NICUs without access to ophthalmology services locally were given on-site training to use RetCam™. Live 2 way audio-video connection allowed monitoring of eye examinations by ophthalmologists at the central reading site to identify significant pathology and continue education and direct refining of imaging technique. Store-forward images were uploaded to a secure ftp server at the reading site and later reviewed by ophthalmologists with experience in management of ROP. Repeat examinations were scheduled according to current guidelines.
Fifty-nine infants underwent 1-6 telemedicine examinations each (total: 145 exams). Images obtained were adequate for assessment on 139 examinations (96%). Repeat imaging was requested on the remaining 6 examinations to improve quality. Seven infants developed ROP, the greatest severity of disease encountered was stage 2 in zone II; all infants with ROP proceeded to show spontaneous ROP regression. All infants underwent binocular indirect ophthalmoscopy (BIO) after discharge home from NICU. ROP that was only identified at time of BIO developed in 3 infants (1 infant developed stage 1 ROP in anterior zone II; 2 developed stage 1 ROP in zone III), none required treatment.
Acquisition of high quality images by NICU staff without prior imaging experience is a difficult skill to master. Continued education through real-time interaction during eye examinations can optimize the learning process, allowing personnel to acquire images with sufficient quality for ROP screening. An in-person BIO is recommended after discharge from NICU to ensure ROP in zone III that may be more difficult to image is identified.
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