Laird Harrison

May 03, 2012

May 3, 2012 (San Jose, California) — Ophthalmologists can effectively screen infants for retinopathy of prematurity by looking at their retinal images from a remote location, researchers reported here at the American Telemedicine Association 17th Annual International Meeting.

Over the course of 4.5 years, 2 pediatric ophthalmologists conducted 582 telemedicine exams on 137 infants using a RetCam II camera (Clarity Medical Systems). They referred 12 infants for worsening retinopathy, 9 of whom needed laser treatment. All had good outcomes, and no cases of retinopathy went overlooked, the researchers report.

"We're one of the first programs to have done this on a remote basis," first author Daniel Weaver, MD, from the Billings Clinic in Montana, told Medscape Medical News.

If retinopathy of prematurity is not diagnosed and treated quickly, it can progress to blindness. The condition is a leading cause of infant blindness worldwide.

However, pediatric ophthalmologists are not available in some rural areas to screen premature infants for this condition, and transferring the infants to medical centers with experts who can make this diagnosis costs a lot of money, Dr. Weaver noted.

Clinicians at the Benefis Health System in Great Falls, Montana, confronted this problem when its only pediatric ophthalmologist left for another job and no one else at the hospital was competent to make the diagnosis. "There were no specialists within 200 miles," Dr. Weaver explained.

Being unable to diagnose retinopathy of prematurity could have forced the clinic to shut down its level 3b neonatal intensive care unit, he said.

The hospital decided to capture and transmit images of premature infants' retinas to the only remaining pediatric ophthalmologists in the state — Dr. Weaver in Billings and Todd Murdock, MD, at the Rocky Mountain Eye Center in Missoula, Montana.

When Dr. Weaver or Dr. Murdock suspected retinopathy approaching the threshold for laser treatment, they had the infants transferred to a hospital where a live exam was performed; if necessary, the infant was treated. None progressed to blindness.

The total cost of transferring the infants who needed treatment was $138,000, said Dr. Weaver. If all the infants needing an examination had been transferred, the cost would have been more than $1.1 million, he said.

One key to the program's success is that the same 3 nurses used the RetCam II. "It's not terribly difficult to do, but you can't just show someone and that's the end of it," said Dr. Weaver.

Asked to comment, Ingrid Zimmer-Galler, MD, a retina specialist at Johns Hopkins University in Baltimore, Maryland, told Medscape Medical News that this study comes at a good time.

"It's an important arena because it's getting harder to find ophthalmologists who diagnose retinopathy of prematurity," said Dr. Zimmer-Galler, who was not associated with the study. "There are very high medical legal risks for these premature babies."

In addition, ophthalmologists who are willing to do the diagnosis are often unwilling to travel to neonatal intensive care units. "There is not enough return for the medical legal risk," she said.

Dr. Weaver and Dr. Zimmer-Galler have disclosed no relevant financial relationships.

American Telemedicine Association (ATA) 17th Annual International Meeting: Abstract P091. Presented April 30, 2012.