August 01, 2006
4 min read

Telemedicine network allows remote assessment of ROP

Network allows doctors and nurses at the neonatal intensive care unit to take images and transmit them to an off-site pediatric retinopathy specialist.

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A telemedicine network can increase the efficiency of screening for retinopathy of prematurity, according to one subspecialist. The network allows him to “visit” multiple hospitals without leaving his computer, he said.

Darius Moshfeghi, MD, a pediatric vitreoretinal specialist at Stanford University, said he developed the network because he was spending countless hours driving to and from scattered San Francisco Bay Area hospitals on a weekly basis, examining infants and making drawings. In a telephone interview with Ocular Surgery News, he said that he realized he could streamline the screening process by training hospital personnel to use a retinal camera, and then connecting the hospitals through the Internet so the retinal images could be sent to him for analysis.

“I was looking at all the weaknesses of the system: You don’t have access to longitudinal data, you really can’t see what’s going on, you don’t have good documentation,” Dr. Moshfeghi said. “If you have four or five or six hospitals that you are involved with, even if they’re calling you in for only one baby, you have to see that baby multiple times in a week. All you’re doing is driving around. It’s not an efficient use of anybody’s time.”

The network, called the Stanford University Network for Diagnosis of Retinopathy of Prematurity, or SUNDROP, was first put into use at Dominican Hospital in Santa Cruz 8 months ago. Since then, Santa Clara Valley Medical Center in San Jose has been added, and there are plans for two more Bay Area hospitals to be included soon.

System advantages

Dr. Moshfeghi said the main benefits of the SUNDROP network, in addition to the reduced driving time for him, are excellent reproducibility and standardization through the use of the retinal camera. Hospitals in the SUNDROP network use the RetCam II by Clarity Medical Systems, he said.

Reproducibility and standardization are difficult to achieve with drawings because of the subjective nature of the medium and the difficulty of recognizing longitudinal changes, he said. In some examinations, a crying baby or other environmental factors can hinder the accuracy of drawings, he said.

“It’s one thing to have a drawing, because a drawing is what I say it is, but a photograph is interpretable by anyone,” he said. “You’re looking from week to week and you’re comparing against drawings that are more a schematic of what’s going on in the eye than a true representation. It’s hard to see incremental changes from a drawing. But it’s easy to see incremental change with a camera.”

How it works

The RetCam II hand-held fiber optic camera can quickly and safely scan a premature infant’s eye in about five minutes.

Image: Moshfeghi D

According to Dr. Moshfeghi, implementation of the network begins with the purchase of the RetCam II by a hospital’s neonatal intensive care unit. Then the NICU personnel must be trained to use it.

Once training is complete, screenings can begin. Using published criteria that recommend when premature infants should be screened for ROP, a nurse or physician dilates the infant’s pupil and uses the contact retinal camera to photograph the eye. The NICU personnel take three to six photographs of each eye under topical anesthesia, using a speculum to hold the eyelid open and a coupling agent between the lens and eye.

If the hospital has a secure link to Packard Children’s Hospital at Stanford University, where Dr. Moshfeghi is on staff, the NICU personnel can e-mail the images. If the hospital does not, a file transfer protocol is used to send the images.

Dr. Moshfeghi reviews the images and files a report. The report assesses the quality of the photographs, what he sees in the photographs, when the patient should be seen again and whether the patient should be referred for treatment.

Three components

He said the system he uses can be replicated in other areas of the country as long as three components are in place.

The first component is that the hospital must obtain the necessary equipment.

The second component is that the NICU personnel must be “dedicated” to using the network, Dr. Moshfeghi said. The size of the hospital does not matter as much as the staff’s ease and familiarity with using the camera, he said. While some nurses and physicians who are not ophthalmologists might be hesitant to use a camera on a premature infant’s tiny eye, he said, that has not so far been an issue with the two hospitals participating in the SUNDROP.

“I was surprised at how quickly the nurses adopted this network and how quickly they became proficient in it. They liked it. At Dominican, they were sending me high quality photos after the first screening,” he said.

Dr. Moshfeghi said he visited the hospitals in the early stages of the installation, helping NICU staff with any problems. Technicians from Clarity Medical Systems were also available to assist with the technology, he said.

The third component necessary for the success of the network, according to Dr. Moshfeghi, is finding a pediatric retina specialist who is willing to read the images. He said specialists benefit from the system because they can screen infants as they continue to perform other work.

For more information:
  • Darius Moshfeghi, MD, is a pediatric vitreoretinal specialist. He can be reached at the Lucile Packard Children’s Hospital at Stanford University, Packard Children’s Hospital, 725 Elch Rd., Palo Alto, CA 94304; e-mail:
  • Clarity Medical Systems Inc., maker of the RetCam II, can be reached at 5775 W. Las Positas Blvd., Pleasanton, CA 94588; 800-215-6005; fax: 925-251-0078; Web site:
  • Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.