Telemedicine addresses challenges of ROP diagnosis

Chicago-Limitations associated with diagnosis of retinopathy of prematurity (ROP) by performing bedside indirect ophthalmoscopy, the current gold standard, is fueling interest in the use of telemedicine, said Michael Chiang, MD, at Pediatric Ophthalmology 2012 in conjunction with the annual meeting of the American Academy of Ophthalmology.

“There is a lot of work going on investigating telemedicine diagnosis of ROP and many questions to be answered. Potentially, however, we may see evolving standards of care,” said Dr. Chiang, Knowles Professor of Ophthalmology & Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland.

Findings from a recently published American Academy of Ophthalmology position paper on telemedicine for ROP diagnosis support the accuracy of the technique. The authors, including Dr. Chiang, reviewed studies on detection of ROP using wide-angle digital retinal photography, including seven studies that were considered to provide Level I evidence. In the latter papers, the sensitivity of telemedicine for diagnosing treatment-requiring ROP compared with the reference standard was 87% to 100%. Three Level III studies, which included data for almost 1,500 babies, reported ROP diagnosis of treatment-requiring ROP had a sensitivity of 100% and specificity of almost 100%.

Results of a study conducted by Dr. Chiang and colleagues comparing ROP diagnosis by evaluation of digital images versus indirect ophthalmoscopy showed agreement between the two techniques in 86% of cases. Considering the 14% of cases where there was a discrepancy, one-third of the time a diagnosis of ROP was made only using the digital images and another one-third of the time, ROP was diagnosed as zone I disease by ophthalmoscopy but zone II by the telemedicine exam.

“Using a digital image allows for identification of landmarks and direct measurements so that the diagnosis by telemedicine can potentially be made more accurately compared with bedside evaluation,” Dr. Chiang said.

Time-motion studies evaluating the ophthalmologist’s time requirement for ROP diagnosis show the telemedicine approach is about three times faster than standard indirect ophthalmoscopy, and findings from a validated survey indicate that parents of infants who received ophthalmoscopic exams and imaging for ROP diagnosis have positive perceptions of telemedicine. Nevertheless, the parents did not seem to want to give up face-to-face meetings with their child’s physician.

“Currently, there are ongoing programs using telemedicine for real-world management of ROP in the United States and internationally, and an ongoing multicenter trial of image-based ROP diagnosis is investigating whether the findings are generalizable,” Dr. Chiang said. “There are also major questions involving real-world policymaking and workflow challenges that need to be answered if telemedicine ROP diagnosis is to become applicable on a large scale.”

Dr. Chiang is an unpaid member of the scientific advisory board for Clarity Medical Systems that markets a wide-angle digital imaging system used in telemedicine ROP diagnosis.

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