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Ian Danford, Miles F Greenwald, Susan Ostmo, Robert Schelonka, Howard S Cohen, J. Peter Campbell, Michael F Chiang; Telemedicine for ROP Diagnosis in a Real-World System: Technical Description and Evaluation. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6531.
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© ARVO (1962-2015); The Authors (2016-present)
Describe and evaluate the implementation of an operational retinopathy of prematurity (ROP) tele-screening program.
We evaluated data from all infants who met ROP screening criteria in the Salem Hospital (SH) neonatal intensive care unit (NICU) between October 2015–October 2018. Nurse practitioners took images with a wide-angle camera (RetCam; Natus Medical Inc., Pleasanton, CA). Images were then transferred to Oregon Health and Science University (OHSU) via a secure VPN connection managed by the SH and OHSU information technology departments. Images were then graded remotely by a pediatric ophthalmologist at OHSU, according to the International Classification of ROP (ICROP) disease severity. Clarity and field of view (FOV) of the images were graded as “acceptable”, “possibly acceptable”, or “not acceptable.” Patients were scheduled for outpatient dilated ophthalmoscopic exams at discharge. We assessed agreement between the last imaging exam and the first follow-up ophthalmoscopic exam.
87 infants (174 eyes) met inclusion criteria. Mean gestational age at birth was 29.09 ± 2.48 weeks with mean birth weight 1238.91 ± 279.44 grams. Telemedical exams detected 2 infants with type 2 or worse disease, who were referred for inpatient treatment. For patients discharged with outpatient follow-up, mean time between last telemedical exam and first outpatient exam was 13.84 days (range: 7 to 61 days), with issues contacting parents of patient with 61 day follow-up. 4 infants did not follow-up at OHSU: 2 due to insurance issues, and 2 traveled back to their home country.There was ICROP severity agreement in 89.63% of eyes (kappa = 0.73) between raters using Retcam and follow-up ophthalmoscopy—indicating substantial agreement. In the 15 eyes with disagreement between exams, 6 (40.00%) were under-diagnosed, all changing from no disease to mild disease. There was no significant difference in percent agreement of severity between eyes with acceptable vs. possibly acceptable image clarity (p = 0.96) or FOV (p = 0.81).
We found substantial agreement between ICROP severity by telemedical imaging and ophthalmoscopic exams in a group of pediatric ophthalmologists. Agreement holds even when retinal image clarity and FOV were comparatively compromised. An important challenge to surmount in an ROP telemedicine program is ensuring close and timely outpatient follow-up after NICU discharge.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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