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Telehealth helps prevent blindness in preemies

Improved technology equips health care providers in remote areas to better diagnose retinopathy of prematurity
Retinopathy of prematurity (ROP)
Jonathan Brown of Keizer, Oregon kisses his son's hand as they wait for their appointment at Elks Children Eye Clinic in Portland. (OHSU/Kristyna Wentz-Graff)

When Keizer, Oregon, resident Mackenzie Brown gave birth at Salem Hospital to her 2.4-pound baby boy, Nathan, at 26 weeks, she knew he would be facing an uphill battle. Nathan was diagnosed with retinopathy of prematurity, or ROP, a common eye disease in premature babies that can cause blindness.

Nationwide, about 3.9 million infants are born each year with ROP, typically those born before 31 weeks’ gestation and weighing about 2.75 pounds or less. Infants diagnosed with ROP often have favorable outcomes, depending on the severity, but it depends on how early they are diagnosed and how they are treated. 

Screening for ROP is challenging because pediatric ophthalmologists are highly specialized, in short supply in more remote areas, and unable to travel easily. 

Retinopathy of prematurity (ROP)
Dr. Michael Chiang (left) greets Jonathan (center) and Mackenzie Brown of Keizer, Oregon during an opthalmologist appointment for their 4-month-old baby Nathan. (OHSU/Kristyna Wentz-Graff)

"When premature babies are born in areas of the country that do not have ROP experts, they are less likely to get diagnosed early on, which helps babies get the early intervention treatment they need to improve outcomes,” says Michael Chiang, M.D., a pediatric ophthalmologist at OHSU’s Elks Children’s Eye Clinic and the Knowles professor of ophthalmology and medical informatics and clinical epidemiology in the OHSU School of Medicine.

Chiang, an expert in ROP and telemedicine, has been researching the effectiveness of using highly accurate imaging technologies to diagnose and monitor ROP via telemedicine. With funding from the Oregon State Elks Association, he and colleagues launched a telemedicine collaboration with Salem Hospital’s neonatal intensive care unit, or NICU. 

This collaboration allowed Chiang to monitor Nathan’s vision remotely while he was in the NICU. During his 105-day stay, nurse practitioners would take pictures of Nathan’s eyes using the imaging technology and then send them through a secure system to Chiang’s team in Portland to review. 

Advances in imaging, computer information and Internet technologies have vastly improved the accuracy of diagnosing and treating premature infants born with ROP via telemedicine, the findings of which were recently published by Chiang in the Journal of the American Association for Pediatric Ophthalmology and Strabismus. 

“Now we have the ability to diagnose patients via wide-angle retinal imaging, computing and information technology that requires minimal technology and expertise for providers in remote areas,” says Chiang.  

Chiang says, in general, the field of pediatric ophthalmology has been slow to adopt the same imaging technologies that have revolutionized the practice of general ophthalmology. A recent survey in the journal Pediatrics of NICUs across the country, in the journal Pediatrics, showed retinal imaging devices were used to screen for primary ROP in only 7 percent of NICUs.

Retinopathy of prematurity (ROP)
Jonathan Brown of Keizer, Oregon and his wife Mackenzie with their son Nathan, who was born at 26-weeks and has retinopathy of prematurity, a common condition in preemies. (OHSU/Kristyna Wentz-Graff)

But research has shown that telemedicine diagnosis of ROP is working: More than 30 published studies have demonstrated that telemedicine has very high accuracy for diagnosing clinically significant ROP. By evaluating other emerging imaging technologies, understanding their benefits and limitations, and gradually implementing them into practice when warranted, pediatric ophthalmologists will be able to enhance the care they provide to patients for a broader range of problems in the future.

“This collaboration highlights the importance of a multidisciplinary approach to clinical care,” says Chiang. “It also demonstrates the pathway by which gaps in the delivery of clinical care motivate research and knowledge discovery, which eventually leads to technology adoption and gradual changes in health care policy.”

Now that Nathan is out of the NICU, Mackenzie and her husband, Jonathan, travel to Portland occasionally for in-person appointments with Chiang’s team. The Browns are hopeful that with the specialized care Nathan received, he will continue to thrive.

Fast Facts (source: National Eye Institute)

  • 3.9 million: number of infants born each year with ROP
  • 28,000: number of infants born each year weighing 2.75 pounds or less
  • 14,000–16,000: number of infants weighing 2.75 pounds or less who are affected by some degree of ROP
  • 90%: percentage of all infants with ROP in the milder category who don't need treatment
  • 1,100–1,500: number of infants who annually develop ROP 
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