Original article
Speed of Telemedicine vs Ophthalmoscopy for Retinopathy of Prematurity Diagnosis

https://doi.org/10.1016/j.ajo.2009.02.002Get rights and content

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.

Section snippets

Study Examiners

All ophthalmoscopic and telemedicine diagnoses in this study were performed by 2 pediatric retinal specialists (R.V.P.C., T.C.L.) and 1 pediatric ophthalmologist (M.F.C.). Each study examiner was experienced in ROP diagnosis and management and was responsible for performing regular ROP examinations at an academic medical center. Each examiner had previously published peer-reviewed studies involving ROP, and 2 (T.C.L., M.F.C.) had served as certified investigators in the Early Treatment for ROP

Results

The time required for telemedicine diagnosis was significantly lower than the time required for diagnosis at the infant bedside for all examiners (P < .0001 for each examiner; Table 1). Mean (± standard deviation [SD]) times for telemedicine diagnosis ranged from 1.02 (± 0.27) minutes to 1.75 (± 0.80) minutes. Mean (± SD) times spent by examiners at the infant bedside for ophthalmoscopic diagnosis ranged from 4.17 (± 1.34) minutes to 6.63 (± 2.28) minutes. The latter times included all of the

Discussion

This study was designed to compare the ophthalmologist's speed of ROP diagnosis using telemedicine vs traditional bedside ophthalmoscopy. Our findings revealed that: 1) ROP diagnosis by the ophthalmologist is significantly faster via telemedicine, and 2) there are significant time requirements by ophthalmologists associated with ROP diagnosis at the NICU bedside beyond ophthalmoscopy. In this study, ophthalmoscopic diagnoses were performed during routine clinical care, whereas telemedicine

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

References (46)

  • S.M. Maviglia et al.

    KnowledgeLink: impact of context-sensitive information retrieval on clinicians' information needs

    J Am Med Inform Assoc

    (2006)
  • Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results

    Arch Ophthalmol

    (1988)
  • Screening examination of premature infants for retinopathy of prematurity

    Pediatrics

    (2001)
  • Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial

    Arch Ophthalmol

    (2003)
  • Screening examination of premature infants for retinopathy of prematurity

    Pediatrics

    (2006)
  • D.L. Phelps

    Retinopathy of prematurity: an estimate of vision loss in the United States—1979

    Pediatrics

    (1981)
  • J.D. Reynolds et al.

    Evidence-based screening criteria for retinopathy of prematurity: natural history data from the CRYO-ROP and LIGHT-ROP studies

    Arch Ophthalmol

    (2002)
  • C.D. Cockey

    Premature births hit record high

    AWHONN Lifelines

    (2005)
  • A.H. Shennan et al.

    Why should preterm births be rising?

    BMJ

    (2006)
  • C. Gilbert 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)
  • A. Vinekar et al.

    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)
  • M.T. Trese

    What is the real gold standard for ROP screening?

    Retina

    (2008)
  • Ophthalmologists warn of shortage in specialists who treat premature babies with blinding eye condition

  • Cited by (41)

    • Pediatric Ocular Telehealth

      2022, Ocular Telehealth: A Practical Guide
    • Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective

      2021, Progress in Retinal and Eye Research
      Citation Excerpt :

      Telemedicine has been shown to be useful in screening for ROP while being fast, cost-effective and having minimal impact on systemic status with several clinical studies reporting favorable long-term results (Brady, D'Amico, and Campbell, 2020). Additionally it is superior to indirect ophthalmoscopy in terms of objective documentation of serial retinal images to inform identify disease progression, and facilitates second opinions, education, and research (Chiang et al., 2012; Isaac et al., 2018; Richter et al., 2009; Shah et al., 2018; Brady, D'Amico, and Campbell, 2020). Recently, smartphone-based fundus imaging (SBFI) has been introduced for screening purposes of ROP and showed competitive outcomes when compared with conventional contact fundus imaging (Goyal et al., 2019; Patel et al., 2019; Wintergerst et al., 2019).

    • A national telemedicine network for retinopathy of prematurity screening

      2018, Journal of AAPOS
      Citation Excerpt :

      The longitudinal method of telemedicine ROP screening allows for serial comparison of multiple photographic examinations, which is particularly important for defining disease progression. In addition, telemedicine may reduce the time commitment for ophthalmologists who manage ROP29 and consequently lower the cost of ROP care.30,31 Telemedicine can provide permanent documentation of ROP disease and avoidance of the need to transport infants to facilities where ROP examinations can be performed in case care cannot be provided locally.

    View all citing articles on Scopus

    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.

    View full text