Speed of Telemedicine vs Ophthalmoscopy for Retinopathy of Prematurity Diagnosis

Richter, Grace M.; Sun, Grace; Lee, Thomas C.; Chan, R.V. Paul; Flynn, John T.; Starren, Justin; Chiang, Michael F.

doi:10.1016/j.ajo.2009.02.002

« Previous Next »American Journal of Ophthalmology
Volume 148, Issue 1 , Pages 136-142.e2, July 2009

Speed of Telemedicine vs Ophthalmoscopy for Retinopathy of Prematurity Diagnosis

Grace M. Richter
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York
- Columbia University Mailman School of Public Health, New York, New York
Grace Sun
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
Thomas C. Lee
- Vision Center, Childrens Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
R.V. Paul Chan
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
John T. Flynn
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York
Justin Starren
- Biomedical Informatics Research Center, Marshfield Clinic, Marshfield, Wisconsin
- Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, New York
Michael F. Chiang
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, New York
- Inquiries to Michael F. Chiang, Departments of Ophthalmology and Biomedical Informatics, Columbia University College of Physicians and Surgeons, 635 West 165th Street, Box 92, New York, NY 10032

Accepted 3 February 2009. published online 20 April 2009.

Purpose

To compare the speed of retinopathy of prematurity (ROP) diagnosis using standard indirect ophthalmoscopy with that of telemedicine.

Design

Prospective, comparative study.

Methods

Three study examiners (2 pediatric retinal specialists [R.V.P.C., T.C.L.] and 1 pediatric ophthalmologist [M.F.C.]) conducted ROP diagnosis via standard indirect ophthalmoscopy and telemedicine. Each examiner performed: 1) standard ophthalmoscopy on 72 to 150 consecutive infants at his respective institution and 2) telemedical diagnosis on 125 consecutive deidentified retinal image sets from infants from an at-risk population. Time for ophthalmoscopic diagnosis was measured in 2 ways: 1) time spent by the examiner at the infant's bedside and 2) mean total time commitment per infant. Time for telemedicine diagnosis was recorded by computer time stamps in the web-based system. For each examiner, nonparametric statistical analysis (Mann–Whitney U test) was used to compare the distribution of times for examination by ophthalmoscopy vs telemedicine.

Results

Mean (± standard deviation [SD]) times for ophthalmoscopic diagnosis ranged from 4.17 (± 1.34) minutes to 6.63 (± 2.28) minutes per infant. Mean (± SD) times for telemedicine diagnosis ranged from 1.02 (± 0.27) minutes to 1.75 (± 0.80) minutes per infant. Telemedicine was significantly faster than ophthalmoscopy (P < .0001). The total time commitment by ophthalmologists performing bedside ophthalmoscopy for ROP diagnosis, including travel and communication with families and hospital staff, was 10.08 (± 2.53) minutes to 14.42 (± 2.64) minutes per infant.

Conclusions

The ophthalmologist time requirement for telemedical ROP diagnosis is significantly less than that for ophthalmoscopic diagnosis. Additional time requirements associated with bedside ROP diagnosis increased this disparity. Telemedicine has potential to alleviate the time commitment for ophthalmologists who manage ROP.