Trained non-physician evaluators studying retinal images transmitted to a reading center successfully identified newborn infants likely to require a medical evaluation for retinopathy (ROP), a leading cause of treatable blindness.

Findings from a new multicenter study strengthen the case for using telemedicine to address unmet medical needs of preterm babies who cannot be initially evaluated by ophthalmologists.

“This study provides validation for a telemedicine approach to ROP screening and could help prevent thousands of kids from going blind,” said lead investigator Graham E. Quinn, M.D., a pediatric ophthalmologist at The Children’s Hospital of Philadelphia and principal investigator of the study, conducted by the e-ROP Cooperative Group collaborating neonatal intensive care units. The National Eye Institute, part of the National Institutes of Health, funded the study published in JAMA Ophthalmology.

The study team analyzed results in 1,257 premature infants in neonatal intensive care units at 12 study centers in the U.S. and one in Canada from 2011 to 2013. On average, the babies were 13 weeks premature and all weighed less than 1251 grams (about 2.75 pounds) at birth.

The infants all received usual care — regularly scheduled diagnostic examinations by an ophthalmologist who determined whether their ROP had a severity that warranted referral for further evaluation (designated RW-ROP). In addition, NICU staff members, called certified retinal imagers, took retinal photographs of all the infants, and those images were transmitted to trained image readers at a central location at the University of Pennsylvania. The image readers, all of them non-physicians, followed a standard protocol to assess whether features of RW-ROP were present in retinal images.

The image readers were unaware of which infants had been designated by the ophthalmologists as needing referral. The two groups had broadly similar results: The image readers identified 90 percent of the infants that ophthalmologists rated as having RW-ROP. When the readers did not find RW-ROP on grading, 87 percent of the time the ophthalmologist had not noted RW-ROP on the examination.

Among the 244 babies that the ophthalmologists identified as having findings consistent with RW-ROP, 162 subsequently received treatment. Of these 162 infants, the non-physician image readers identified RW-ROP in 159 of them, meaning that 98 times out of a 100, the eye was identified as a high-risk eye.

Quinn added that further studies should be done to discover whether the results are generalizable to infants not covered in this study, such as preterm babies with higher birth weights than 1251 grams. Interested hospitals would need to acquire special cameras for taking retinal images, as well as training NICU staff and establishing remote image reading centers.

The study is available here.

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