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Speed of Telemedicine vs Ophthalmoscopy for Retinopathy of Prematurity Diagnosis

Published:April 20, 2009DOI:https://doi.org/10.1016/j.ajo.2009.02.002

      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.
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      References

        • Cryotherapy for Retinopathy of Prematurity Cooperative Group
        Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results.
        Arch Ophthalmol. 1988; 106: 471-479
        • Section on Ophthalmology American Academy of Pediatrics
        • American Academy of Ophthalmology
        • American Association for Pediatric Ophthalmology and Strabismus
        Screening examination of premature infants for retinopathy of prematurity.
        Pediatrics. 2001; 108: 809-811
        • Early Treatment for Retinopathy of Prematurity Cooperative Group
        Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial.
        Arch Ophthalmol. 2003; 121: 1684-1694
        • Section on Ophthalmology American Academy of Pediatrics
        • American Academy of Ophthalmology
        • American Association for Pediatric Ophthalmology and Strabismus
        Screening examination of premature infants for retinopathy of prematurity.
        Pediatrics. 2006; 117: 572-576
        • Phelps D.L.
        Retinopathy of prematurity: an estimate of vision loss in the United States—1979.
        Pediatrics. 1981; 67: 924-925
        • Reynolds J.D.
        • Dobson V.
        • Quinn G.E.
        • et al.
        Evidence-based screening criteria for retinopathy of prematurity: natural history data from the CRYO-ROP and LIGHT-ROP studies.
        Arch Ophthalmol. 2002; 120: 1470-1476
        • Cockey C.D.
        Premature births hit record high.
        AWHONN Lifelines. 2005; 9: 365-370
        • Shennan A.H.
        • Bewley S.
        Why should preterm births be rising?.
        BMJ. 2006; 332: 924-925
        • Gilbert C.
        Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control.
        Early Hum Dev. 2008; 84: 77-82
        • Gilbert C.
        • Fielder A.
        • Gordillo L.
        • et al.
        Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: implications for screening programs.
        Pediatrics. 2005; 115: e518-e525
        • Chen Y.
        • Li X.
        Characteristics of severe retinopathy of prematurity patients in China: a repeat of the first epidemic?.
        Br J Ophthalmol. 2006; 90: 268-271
        • Gilbert C.
        • Rahi J.
        • Eckstein M.
        • O'Sullivan J.
        • Foster A.
        Retinopathy of prematurity in middle-income countries.
        Lancet. 1997; 350: 12-14
        • Vinekar A.
        • Dogra M.R.
        • Sangtam T.
        • Narang A.
        • Gupta A.
        Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: ten years data from a tertiary care center in a developing country.
        Indian J Ophthalmol. 2007; 55: 331-336
        • Trese M.T.
        What is the real gold standard for ROP screening?.
        Retina. 2008; 28: S1-S2
        • American Academy of Ophthalmology
        Ophthalmologists warn of shortage in specialists who treat premature babies with blinding eye condition.
        (Accessed: August 6, 2008)
        • Callahan C.W.
        • Malone F.
        • Estroff D.
        • Person D.A.
        Effectiveness of an internet-based store-and-forward telemedicine system for pediatric subspecialty consultation.
        Arch Pediatr Adolesc Med. 2005; 159: 389-393
        • Sable C.A.
        • Cummings S.D.
        • Pearson G.D.
        • et al.
        Impact of telemedicine on the practice of pediatric cardiology in community hospitals.
        Pediatrics. 2002; 109: E3
        • Whited J.D.
        • Hall R.P.
        • Simel D.L.
        • et al.
        Reliability and accuracy of dermatologists' clinic-based and digital image consultations.
        J Am Acad Dermatol. 1999; 41: 693-702
        • Balasubramanian M.
        • Capone A.
        • Hartnett M.E.
        • et al.
        The Photographic Screening for Retinopathy of Prematurity Study (Photo-ROP): primary outcomes.
        Retina. 2008; 28: S47-S54
        • Chiang M.F.
        • Keenan J.D.
        • Starren J.
        • et al.
        Accuracy and reliability of remote retinopathy of prematurity diagnosis.
        Arch Ophthalmol. 2006; 124: 322-327
        • Chiang M.F.
        • Wang L.
        • Busuioc M.
        • et al.
        Telemedical retinopathy of prematurity diagnosis: accuracy, reliability, and image quality.
        Arch Ophthalmol. 2007; 125: 1531-1538
        • Chiang M.F.
        • Starren J.
        • Du Y.E.
        • et al.
        Remote image-based retinopathy of prematurity diagnosis: a receiver operating characteristic analysis of accuracy.
        Br J Ophthalmol. 2006; 90: 1292-1296
        • Ells A.L.
        • Holmes J.M.
        • Astle W.F.
        • et al.
        Telemedicine approach to screening for severe retinopathy of prematurity: a pilot study.
        Ophthalmology. 2003; 110: 2113-2117
        • Murakami Y.
        • Jain A.
        • Silva R.
        • Lad E.
        • Gandhi J.
        • Moshfeghi D.
        Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 12-month experience with telemedicine screening.
        Br J Ophthalmol. 2008; 92: 1456-1460
        • Roth D.B.
        • Morales D.
        • Feuer W.J.
        • et al.
        Screening for retinopathy of prematurity employing the RetCam 120: sensitivity and specificity.
        Arch Ophthalmol. 2001; 119: 268-272
        • Schwartz S.D.
        • Harrison S.A.
        • Ferrone P.J.
        • Trese M.T.
        Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera.
        Ophthalmology. 2000; 107: 25-28
        • Scott K.E.
        • Kim D.Y.
        • Wang L.
        • et al.
        Telemedical diagnosis of retinopathy of prematurity: intraphysician agreement between ophthalmoscopic examination and image-based interpretation.
        Ophthalmology. 2008; 115: 1222-1228.e3
        • Shah P.K.
        • Narendran V.
        • Saravanan V.R.
        • et al.
        Screening for retinopathy of prematurity—a comparison between binocular indirect ophthalmoscopy and RetCam 120.
        Indian J Ophthalmol. 2006; 54: 35-38
        • Silva R.A.
        • Murakami Y.
        • Jain A.
        • et al.
        Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 18-month experience with telemedicine screening.
        Graefes Arch Clin Exp Ophthalmol. 2009; 247: 129-136
        • Wu C.
        • Petersen R.A.
        • VanderVeen D.K.
        RetCam imaging for retinopathy of prematurity screening.
        J AAPOS. 2006; 10: 107-111
        • Yen K.G.
        • Hess D.
        • Burke B.
        • et al.
        Telephotoscreening to detect retinopathy of prematurity: preliminary study of the optimum time to employ digital fundus camera imaging to detect ROP.
        J AAPOS. 2002; 6: 64-70
        • Jackson K.M.
        • Scott K.E.
        • Graff Zivin J.
        • et al.
        Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management.
        Arch Ophthalmol. 2008; 126: 493-499
        • Kemper A.R.
        • Wallace D.K.
        Neonatologists' practices and experiences in arranging retinopathy of prematurity screening services.
        Pediatrics. 2007; 120: 527-531
        • Mukherjee A.N.W.P.
        • Al-Madfai H.
        • Manoj B.
        • Roberts D.
        Impact of retinopathy of prematurity screening examination on cardiorespiratory indices—a comparison of indirect ophthalmoscopy and RetCam imaging.
        Ophthalmology. 2006; 113: 1547-1552
        • Maloney K.
        • Hamlet C.T.
        The clinical display of radiologic information as an interactive multimedia report.
        J Digit Imaging. 1999; 12: 119-121
        • Maviglia S.M.
        • Yoon C.S.
        • Bates D.W.
        • Kuperman G.
        KnowledgeLink: impact of context-sensitive information retrieval on clinicians' information needs.
        J Am Med Inform Assoc. 2006; 13: 67-73
        • Eysenbach G.
        • Powell J.
        • Kuss O.
        • Sa E.R.
        Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review.
        JAMA. 2002; 287: 2691-2700
        • Woolf S.H.
        • Chan E.C.
        • Harris R.
        • et al.
        Promoting informed choice: transforming health care to dispense knowledge for decision making.
        Ann Intern Med. 2005; 143: 293-300
        • Chiang M.F.
        • Boland M.V.
        • Margolis J.W.
        • et al.
        Adoption and perceptions of electronic health record systems by ophthalmologists: an American Academy of Ophthalmology survey.
        Ophthalmology. 2008; 115: 1591-1597
        • Dobke M.K.
        • Bhavsar D.
        • Gosman A.
        • et al.
        Pilot trial of telemedicine as a decision aid for patients with chronic wounds.
        Telemed J E Health. 2008; 14: 245-249
        • Kollmann A.
        • Hayn D.
        • Garcia J.
        • et al.
        Initial experiences with a telemedicine framework for remote pacemaker follow-up.
        Conf Proc IEEE Eng Med Biol Soc. 2006; 1: 5218-5221
        • Shashidhar V.M.
        • Brauchli K.
        • Oberholzer M.
        • et al.
        Pacific Telepathology Service at Fiji School of Medicine.
        Pac Health Dialog. 2003; 10: 178-181
        • LaMonte M.P.
        • Bahouth M.N.
        • Xiao Y.
        • et al.
        Outcomes from a comprehensive stroke telemedicine program.
        Telemed J E Health. 2008; 14: 339-344
        • Anvari M.
        Impact of information technology on human resources in healthcare.
        Healthc Q. 2007; 10: 84-88
        • Campino A.
        • Lopez-Herrera M.C.
        • Lopez-de-Heredia I.
        • Valls-I-Soler A.
        Medication errors in a neonatal intensive care unit.
        Acta Paediatr. 2008; 97: 1591-1594
        • Eckmanns T.
        • Bessert J.
        • Behnke M.
        • Gastmeier P.
        • Ruden H.
        Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect.
        Infect Control Hosp Epidemiol. 2006; 27: 931-934

      Biography

      Michael F. Chiang is an Irving Assistant Professor of Ophthalmology and Biomedical Informatics at Columbia University, New York, New York. His research involves implementation and evaluation of telemedicine and electronic health record systems. Dr Chiang received a BS in Electrical Engineering and Biology from Stanford University, an MD from Harvard Medical School and Harvard-MIT Division of Health Sciences and Technology, and an MA in Biomedical Informatics from Columbia University. Dr Chiang completed residency and pediatric ophthalmology fellowship training at the Johns Hopkins Wilmer Eye Institute.

      Biography

      Grace M. Richter will graduate in May 2009 from Columbia University College of Physicians and Surgeons and Mailman School of Public Health with an MD/MPH dual degree. She graduated summa cum laude from Washington University, St Louis, Missouri, in 2004 with a BA in Chemistry and International Studies. Grace plans to pursue an ophthalmology residency, and her current special interests include public health, ocular epidemiology, and international ophthalmology.