Abstract
Purpose :
To investigate risk and benefits of implementing telemedicine with fundus photographs obtained using the ICON GO® by a non-physician healthcare professional (NPHP), in screening for retinopathy of prematurity (ROP). We tested the hypothesis that a physician rarely needs to repeat the examination performed by a NPHP. Second endpoint was to evaluate the level of agreement between two independent ROP graders based on the fundus photographs.
Methods :
National ROP screenings criteria for the preterm children were gestational age (GA) of less than 32 weeks or birthweight (BW) less than 1500 gram. Exclusions criteria were children born outside the Capital Region and examinations performed by other than a NPHP. A total of 630 screenings were performed, of which 191 were done by a physician and hence excluded. Included in the study was 439 screenings performed by NPHP on 176 children (53% males) from 28th of august 2022- 25th of September 2023 in the Capital Region of Denmark at 4 different neonatal intensive care units. The screenings were performed with the ICON GO®, and the NPHP selected the best images for evaluation by a bed-side ophthalmologist. The bed-side screener evaluated whether a re-examination with ophthalmoscopy or photography was necessary and if so, whether the re-examination was beneficial or not. Lastly, the captured images were digitally evaluated by two independent ophthalmologists, regarding scheduling next screening or treatment for Type 1 ROP.
Results :
Of 439 screenings a re-examination, with indirect ophthalmoscopy performed by the bed-side ophthalmologist, was necessary in 3 screening sessions and beneficial in two cases. Mean birth parameters were GA 28.5±2.4 (23-33) and BW 1211±390 (418-2315). Among children offered screening; 59% had no ROP, 34% had some stage of ROP not requiring treatment and lastly 7% had Type 1 ROP requiring treatment. The level of agreement between the ophthalmologists for Type 1 ROP was 100%.
Conclusions :
Telemedicine screening with the ICON GO® camera can effectively detect Type 1 ROP when performed by NPHP and as hypothesized rarely needs to be repeated. A standardized education and certification for imaging ROP should be set up for health care professionals to ensure patient safety. This setup can open up possibilities for implementing telemedicine on a national level in Denmark.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.