With tele-healthcare use on the rise despite its barriers, it is surprising that its penetration in retinopathy of prematurity (ROP) screening is not higher than 21%, according to Antonio Capone, Jr., MD.
A survey of medical directors at 393 level III neonatal intensive care units found 44% of the directors did not think there were enough ophthalmologists to screen and/or treat ROP in their local area.1
ROP surveillance is a workflow process, with “an established disease management algorithm,” said Dr. Capone (see Figure 1), adding numerous studies have demonstrated the validity of the telemedicine paradigm for ROP surveillance.
Dr. Capone is clinical professor of biomedical sciences, Oakland University William Beaumont School of Medicine, Rochester Hills, MI, and is in private practice at Associated Retinal Consultants, Royal Oak, MI.
Digital fundus imaging, performed weekly, “[fortifies] the safety net for eyes where aggressive disease can be missed,” after initial screening, Dr. Capone said.
“Digital imaging is more cost effective and significantly more time efficient for physicians,” he added. “A further advantage is that digital data are available for objective review, dissemination, and second-opinion consultation.”
For infants followed with digital imaging, ophthalmoscopy is performed within 72 hours of the final imaging session as a segue to outpatient surveillance. Finding Zone 1 and plus disease is easier with digital imaging, and are “more cost effective and significantly more time-efficient,” he said. Both are key advantages in view of the manpower challenges of ROP and the high screen-to-treat ratio. Software programs can further delineate findings.
Dr. Capone listed both didactic (www.focusrop.com/home/education) and case-based (aao.org/pediatric-center-detail/retinopathy-of-prematurity-case-based-training) online resources as useful education tools for clinicians.