Attitudes towards telemedicine for screening of retinopathy of prematurity amongst NICU directors

Abstract

Purpose : The purpose of this study is to assess demographic characteristics and attitudes towards telemedicine in retinopathy of prematurity (ROP) screening in NICUs that have access to a retinal imaging device, a group that may represent early adopters of artificial intelligence telescreening for ROP.

Methods : A subanalysis of previous United States survey data from Vartanian et al (2015) that assessed 840 Level III and IV NICU directors was performed, specifically analyzing responses from NICU directors that screened for ROP and had a retinal imaging device. The original survey was conducted via mailed surveys to medical directors of 847 Level III NICUs identified in the American Academy of Pediatrics directory. Demographic characteristics and attitudes to specific statements regarding telemedicine were assessed. Statistical analysis was performed in Stata (Version 13.1 for Mac, StataCorp, College Station, TX).

Results : Of the 378 NICUs that screened for ROP, only 26 (6.9%) used a retinal imaging device as the primary method for screening (Group A) and 52 (13.7%) used a retinal imaging device in addition to a bedside examination (Group B). Of the NICU directors in Group A, all were board certified neonatologists, 11 (42.3%) had a primary appointment at an academic medical institution and 20 (76.9%) had 5-10+ years of experience in their current role. NICU directors in Group A were more likely to agree that a retinal imaging device could replace in-person screening (73.1% compared to 28.8% in Group B, p=0.0005). They were also more likely to agree that telemedicine for ROP is safe (76.9% compared to 25.0% in Group B, p<0.0001). More NICU directors in Group A agreed that a well-trained non-physician reader could be relied upon to review ROP exams and determine the need for referral to an ophthalmologist (30.8% compared to 19.2%, p=0.39).

Conclusions : NICU directors that had previous experience with retinal imaging primarily for telemedicine in ROP had more positive attitudes towards telemedicine compared to those who used it as an adjunct to bedside screening. Further research is needed to understand how the neonatology and ophthalmology communities can shift towards imaging as the standard of care for ROP documentation and diagnosis.
The results from this analysis are being used to develop a follow-up survey to identify barriers to AI-assisted telescreening amongst NICU directors.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.