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Michael Thomas Trese, Kimberly Drenser, Antonio Capone; Telemedicine for ROP Screening. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5905.
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Retinopathy of prematuity screening is the key element for good ROP care allowing well timed treatment which can result in highly successful results from laser and early vitrectomy treatment. Customarily ROP screening has been done by doctors doing on average at our institution 6 exam per baby prior to discharge from the NICU. ROP is a very serious disease but only about 18% of eyes require treatment by a physician. In addition bedside exams are often documented by retinal drawing by the doctor which can lead to human error. A photograph can be studied and shared with accuracy with the neonatologist, NICU staff, and parents, and sent for remote readings by skilled readers in any location avoiding travel time for the examiner and time in the nursery. Handling of images must follow privacy laws and provide accurate representation of retinal findings that trigger bedside exam and treatment. It has been proven in several studies that telemedicine can transfer images accurately, but software also can be designed to reduce human error.
FocusROP software was designed to reduce human error in two areas of telemedicine, as well as reducing the need for doctor time doing ROP examinations in the NICU, thereby reducing cost of ROP screening and providing photographic documentation. Two areas of potential human error are image uploading by the NICU nurse and, for doctors, timing of the next examination as ROP is very time sensitive. Exams that extend the next exam by only a few weeks can result in a disasterous sequence of events and missing a treatment interval. The FocusROP software overcomes these issues by using an oriented upload pattern that makes erroneous image loading less possible, and the examination schedual is fixed based on the observed findings and randomized study recommendations and not changeable by the doctor, therefore error in exam schedule is not possible. We have used this system in a two hospital system for 3 years, well over 2 500 exams.
We have reduced the indicated doctor preformed bedside exams by 84% and no baby has missed a treatment interval. After instruction there were only 10 uploading errors by NICU nurses.
Photographic documentation and telemedicine management of ROP care with intelligent software can provide better documentation, safer screening, and less doctor time going to and in the NICU therefore reducing cost of ROP screening . Telemedicine for ROP is the future of screening for ROP.
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