Baby being examined (c) Discovery Eye |
Modern technology, including the development of wide-angle ocular digital fundus photography, coupled with the ability to send digital images electronically to remote locations, has led to the development of telemedicine-based remote digital fundus imaging evaluation (and capture) techniques. These techniques have the potential to allow the diagnosis and monitoring of ROP to occur in lieu of the necessity for some repeated on-site examinations in NICUs.
RetCam 3 (c) Clarity Medical System |
Although there is an ongoing need for screening for ROP, reimbursement issues, liability concerns, and the complexities associated with coordinating ROP services are possibly resulting in insufficient numbers of qualified ophthalmologists willing to provide screening for infants at risk for developing ROP. Although malpractice claims against ophthalmologists and neonatologists for failure of diagnosis or mismanagement of ROP are relatively uncommon, awards can be extremely high because of the age of the patients involved and the severity of visual disability that may occur.
ROP (c) NEI |
Walter M. Fierson, MD, and Antonio Capone, Jr, MD reviewed the literature on the success of telemedicine-based remote digital fundus imaging and found it does not eliminate the need for binocular indirect ophthalmoscopy but can expand options for treatment and improve outcomes for some at-risk patients. Their findings were published online in Pediatrics, with some of the details mentioned below.
Dr Trese examining a baby (c) Business Wire |
Disadvantages include the cost and the fact that the telemedicine systems collect considerably less information than is required to fully stage the extent of ROP on the basis of the International Classification of Retinopathy of Prematurity consensus statement. Detractors cite the difficulty in imaging the retinal periphery, problems with image quality in certain circumstances (eyes with poor dilation, media haze, or dark fundus pigmentation), and variations in interpretations of images even among highly skilled clinicians.
Considerations should include costs for a digital fundus camera system, image management software, training for nursing teams, and an ophthalmologist with expertise in ROP.
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