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Telemedicine provides accurate diagnosis of rare cause of blindness in preemies

OHSU study find little difference between in-person, remote exams
Retinopathy of prematurity (ROP)
Jonathan Brown of Keizer, Oregon and his wife Mackenzie with their 4-month-old baby's Nathan, at Casey Eye Institute Elks Children Eye Clinic. Nathan was born at 26-weeks and spent his first 105 days in the NICU. He developed retinopathy of prematurity, so during his NICU stay his vision was monitored remotely by ophthalmologists in Portland using secure telemedicine technology. (OHSU/Kristyna Wentz-Graff)

Accurately detecting a rare but devastating cause of blindness in premature babies can be done as effectively with telemedicine as with traditional, in-person eye exams, a study published in JAMA Ophthalmology suggests. This is believed to be the first study to directly compare the two approaches.

The finding could enable more blindness-preventing treatment for infants born in rural and other areas where there are few ophthalmologists trained to detect the condition, called retinopathy of prematurity, or ROP. Musician Stevie Wonder went blind due to this condition.

Michael Chiang, M.D.
Michael Chiang, M.D.

“A lack of access to trained ophthalmologists with experience diagnosing ROP sadly prevents many premature infants from receiving much-needed screening, both in developed and developing countries,” said the study’s lead researcher, Michael F. Chiang, M.D., a professor of ophthalmology and medical informatics & clinical epidemiology in the OHSU School of Medicine and a pediatric ophthalmologist at OHSU’s Elks Children’s Eye Clinic.

The study’s first authors are Hilal Biten, M.D., and Travis Redd, M.D., M.P.H. Redd is an OHSU ophthalmology resident and Biten was a visiting OHSU scholar who now works at Ankara Numun Training and Research Hospital in Turkey.

Retinopathy of prematurity is caused by abnormal blood vessel growth near the retina, the light-sensitive portion in the back of an eye. The National Eye Institute of the National Institutes of Health reports that while up to 16,000 U.S. babies experience the condition to some degree, only 400 to 600 become legally blind each year as a result.

Some U.S. medical associations recommend an in-person exam, which involves a special magnifying device that shines light into a baby’s dilated eye, to diagnose the condition. But trained professionals aren’t always easy to find in rural areas and developing countries.

screen showing the image of an eye, with two doctors in front in discussion
Michael Chiang reviews images of a preemie's eyes via telemedicine. A new study shows blindness-preventing treatment for premature babies can be done as effectively with telemedicine as with traditional, in-person eye exams. (OHSU)

The research team compared the accuracy of in-person exams with digital eye images that were remotely evaluated by professionals. They partnered with seven medical institutions to examine the eyes of 281 infants who were at risk for the condition. Each eye was evaluated both in-person and remotely with a wide-angle telemedicine image.

The researchers found there was no difference in the overall accuracy between the two evaluation methods. In-person examiners were found to be slightly better at accurately diagnosing the condition’s later-stage development, but the research team concluded telemedicine could be used to diagnose clinically significant cases of retinopathy of prematurity.

The institutions involved in this study were OHSU, Weill Cornell Medical College, University of Illinois at Chicago, University of Miami, Columbia University Medical Center, Children’s Hospital Los Angeles, Cedars-Sinai Medical Center and Asociación para Evitar la Ceguera en México.

This research was organized through the OHSU-led Imaging and Informatics in Retinopathy of Prematurity Research Consortium, which is supported by the National Institutes of Health (grants R01EY019474 and P30EY10572, the National Science Foundation (grants SCH-1622679, SCH-1622542, SCH-1622536), Research to Prevent Blindness and Oregon State Elks.

REFERENCE: Hilal Biten, Travis K Redd, Chace Moleta, J Peter Campbell, Susan Ostmo, Karyn Jonas, RV Paul Chan, Michael F Chiang, “Diagnostic accuracy of ophthalmoscopy vs telemedicine in examinations for retinopathy of prematurity,” JAMA Ophthalmology, April 5, 2018, DOI: 10.1001/jamaophthalmol.2018.0649.

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