Success of remote screening for diagnosing eye disease in premature infants

Pleasanton 01 June 2005In a major step forward for the care of premature infants as well as telemedicine, new research shows that remote screening for retinopathy of prematurity (ROP) can be accomplished as effectively as bedside diagnosis, and with potentially greater efficiency. These findings from the international Photographic Screening Study for ROP (PhotoROP) were presented at the recent annual meeting of the Association for Research for Vision and Ophthalmology (ARVO).

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Retinopathy of prematurity (ROP) is a serious eye disorder, caused by premature birth, that can result in significant visual loss or even blindness if the condition is not diagnosed and treated quickly. Recent research supports the need to screen some premature babies as often as twice a week. However, there isn't always a specialist on-site to perform the exam. In such cases, screening is not performed or is postponed, or babies are transported back and forth between institutions.

In the prospective, multicentre PhotoROP study, infants were examined at bedside with the current imaging standard (indirect ophthalmoscope) and remotely with the RetCam Digital Imaging System. The study sought to detect clinically significant ROP (CSROP), in other words, ROP that warranted referral to a paediatric eye specialist for potential treatment. Using the RetCam, researchers accurately diagnosed CSROP in 100 percent of patients as detected by indirect ophthalmoscopy. Furthermore, the condition was identified on average 1 to 2 weeks earlier than with the standard technique.

"We're learning more and more about the importance of frequent and early screening for ROP but for many years now we've used the same technique to perform this examination", stated Alistair Fielder, FRCS, Professor of Ophthalmology at the Institute of Health Sciences of City University in London, who participated in this research as well as in the PhotoROP study. "We are in great need of new screening strategies, especially to help address infants in less accessible and less developed areas of the world. Technology such as the RetCam is an important step in that direction."

"In this study, we didn't miss a single case of CSROP through remote screening, plus we gained valuable time in making the diagnosis", added Anna Ells, MD, Associate Professor of Surgery at Alberta's Children's Hospital in Calgary, who presented the data at ARVO on behalf of the PhotoROP investigators. "We've now shown that remote screening is feasible, effective and reliable. Given the huge manpower demands for ROP screening, this has significant practical and clinical implications for improving the care of these neonates."

The RetCam is a unique integrated system that combines first-ever bedside wide-angle viewing, full resolution image selection from real-time digital video with a comprehensive relational database. The availability of an immediate image means that precise diagnostic comparisons can be made over time, rather than relying on inexact drawings in a patient's chart. The digital capability also enables remote image transfer, so that the clinician no longer needs to be in the same room, or even the same country, as the patient.

"Being able to screen infants from a distance is an exceedingly important clinical development", stated Antonio Capone, Jr., MD, Director of the Fellowship in Vitreoretinal Diseases and Surgery at William Beaumont Hospital in Royal Oak, Michigan, and co-lead investigator of the PhotoROP study. "For the first time, we can ensure that examinations are performed effectively and frequently no matter where the patient is. It's difficult to overstate the potential significance of this advance for saving the eyesight of many premature babies."

Diagnostic improvements such as the RetCam are critical because research indicates that the rate of severe eye disease in premature infants is increasing. In another report presented at ARVO, Dr. Ells' team reviewed all cases from their institution's neonatal intensive care unit (NICU) over the last decade, comparing 1995-1999 and 2000-2004. Their findings were dramatic.

"In the most recent five years, the number of severe ROP cases more than doubled compared to the five years prior", Dr. Ells explained. "This is likely due to advances in technology that allow younger and younger babies to survive."

The RetCam promises to improve diagnosis of ROP beyond just remote screening as demonstrated in other new research presented during ARVO. In one report, the RetCam system was used to document and monitor the development of a particularly severe and rapidly progressing form of ROP, called aggressive posterior ROP (AP-ROP). The findings, from an international group of United Kingdom, United States and Canadian researchers, are the first to demonstrate the unique clinical features that are crucial for early identification, treatment and prevention of AP-ROP.

MLI Inc., makers of RetCam Digital Imaging Systems, is a medical device company that develops, manufactures and markets integrated optical systems and services to enhance the clinician's ability to diagnose, manage and treat eye disorders. These patented devices combine innovative advanced optical, electronic and information technologies that change the very nature of the way eye health care is delivered.

The RetCam family of integrated digital systems has revolutionized the standard of ophthalmologic evaluation in infants and children, helping to improve the diagnosis and documentation of such conditions as retinopathy of prematurity (ROP), paediatric eye cancer (retinoblastoma) and the effects of child abuse in shaken baby syndrome. The RetCam's advanced imaging technology is being used by leading medical centres worldwide, including many of the foremost United Kingdom, European and United States children's hospitals.


Leslie Versweyveld

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