Telemedicine screening for retinopathy of prematurity reduces transfers, costs

COS 2012, July 5 - An Ontario-based telemedicine program designed to screen for retinopathy of prematurity (ROP) has several advantages when it comes to getting expertise to remote communities. It's useful for teaching personnel to perform optical imaging, reduces the need for inter-hospital transfers and could provide substantial savings in health care costs.

This comes from the three-year results of a retrospective chart review of the screening program between two remote neonatal intensive care units (NICUs) - a level II NICU and a modified level III NICU - and a central reading site. The technology uses real-time, two-way audiovisual connections between sites and is part of the Ontario Telemedicine Network.

A description of the program was presented in a talk at the COS meeting and in a poster at the IOC in Toronto by Dr. Nasrin Tehrani, an assistant professor of ophthalmology and vision sciences, University of Toronto.

There is limited access to ophthalmologists for patients in much of the province, due to Ontario's vast geography. About 12,150 examinations per year are performed by fewer than 100 ophthalmologists, and many communities have no ophthalmologist. This often leads to inter-hospital transfers of infants for eye exams. A single transfer from Sudbury to Sick Kids in Toronto costs about $30,000, she said.

With the telemedicine system, ROP screening is scheduled according to current guidelines. The live connection allows for the monitoring of eye examinations and continued education by ophthalmologists from the central reading site. Infants were transferred for in-person examinations if there were type 2 ROP (or worse) indicators, inadequate image quality or other problems.

At the end of three years, 79 infants were screened through 168 telemedicine imaging sessions (including follow-up imaging). High-quality images were obtained on first attempt 155 times. In 14 cases, ROP was detected using the images; another three cases were detected in person.

In this series, all infants who developed ROP had the condition spontaneously regress without treatment, and none required transfer. Tehrani noted there were no complications from the imaging.