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B. A. Griffiths, K. Azzeh, N. N. Tehrani; Remote Screening for Retinopathy of Prematurity (ROP) Using Telemedicine: Canadian Experience. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5909.
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We describe our experience of using telemedicine strategies in bringing care to infants at risk of ROP in a remote center in Canada where access to ophthalmologists with expertise in ROP is limited.
Neonatal nurses and physicians in a regional level II nursery (remote site) were trained to obtain digital images of retina following standardized protocol. Continued training during imaging was provided using real time interaction through a secure video connection via telehealth network between reading center and remote site. Images obtained were uploaded to a secure ftp server, reviewed by ophthalmologist at reading center and report faxed to remote site. Follow up was arranged according to agreed guidelines for ROP screening. Infants underwent binocular indirect ophthalmoscopy at reading center following discharge from the nursery or if they developed ROP severe enough to warrant referral. Data was collected prospectively using previously agreed criteria including:- Interventions for cardio-respiratory support within 24hrs of imaging- Cessation of imaging due to oxygen desaturation / bradycardia during imaging- Whether additional re-examination was requested due to insufficient quality of images to allow accurate assessment by reading center- Parent satisfaction surveys
Twenty infants underwent screening for ROP. Thirty three separate examinations were performed and 1188 images obtained. No infant developed severe ROP to warrant referral to the reading center therefore avoiding 33 separate transfers between the 2 sites. There were no instances where imaging had to be stopped and we did not need to re image any infant due to inadequate image quality.
Our early experience suggests remote screening for ROP utilizing telemedicine strategies can help prevent inter hospital transfers for these fragile neonates. The infants in our series did not develop severe ROP requiring referral to reading center. Video connection between the 2 sites for real time interaction allowed personnel without previous imaging experience to acquire images with sufficient quality for appropriate assessment.
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