Speed of Telemedicine vs Ophthalmoscopy for Retinopathy of Prematurity Diagnosis

Published:April 20, 2009DOI:


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


      Prospective, comparative study.


      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.


      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.


      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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      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.


      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.