NEW YORK (Reuters Health) – Telemedicine has similar accuracy to ophthalmoscopy in detecting clinically significant retinopathy of prematurity (ROP), researchers say.
“ROP is a leading cause of childhood blindness in the U.S. and throughout the world, yet it is often difficult to find qualified ophthalmologists to care for infants with this disease,” Dr. Michael Chiang of Oregon Health and Science University (OHSU) in Portland told Reuters Health.
“Telemedicine has potential to improve the quality, accessibility, and cost of ROP care,” he said by email.
Many previous studies have looked at whether telemedicine is useful for diagnosing ROP, he noted. “However, to my knowledge, all of those previous studies have assessed the accuracy of telemedicine by assuming that a traditional in-person eye examination gives the ‘correct’ answer.”
“In our research and clinical practice at OHSU, we have seen many cases where telemedicine examination gives a more accurate diagnosis than traditional in-person eye examinations,” he said. “This is because these babies can be very difficult to examine – they are small and fragile, and their eyes are often difficult to examine carefully using traditional methods.”
“To my knowledge, this is the first study to directly compare the accuracy of telemedicine examinations to the accuracy of traditional in-person eye examinations,” Dr. Chiang said. “We found that these methods were similarly accurate for diagnosing clinically significant ROP disease.”
Dr. Chiang and colleagues examined the eyes of 281 premature infants (mean gestational age, 27 weeks; 54% boys) at seven neonatal intensive care units in the U.S. and Mexico.
Each examination consisted of one eye undergoing binocular indirect ophthalmoscopy by an experienced clinician followed by remote image review of wide-angle fundus photographs by three telemedicine graders.
As reported online April 5 in JAMA Ophthalmology, a total of 1,553 eye examinations were classified using both ophthalmoscopy and telemedicine. No difference was found in overall accuracy between the two for the detection of clinically significant ROP; however, on average, ophthalmoscopy had slightly higher accuracy for the diagnosis of zone III and stage 3 ROP.
Specifically, ophthalmoscopy and telemedicine each had similar sensitivity for zone I disease (78% each); plus disease (74% vs. 79%, respectively); and type 2 ROP (stage 3, zone I, or plus disease: 86% vs. 79%). Ophthalmoscopy was slightly more sensitive in identifying stage 3 disease (85% vs. 73%).
“We also found that there was often variability in ROP diagnosis among different ophthalmologists, regardless of whether they were performing examinations using telemedicine or using traditional in-person methods,” Dr. Chiang noted.
“This study suggests that who performs the eye examination is ultimately more important than whether that person is using telemedicine or traditional in-person eye examination,” he said.
“This has important implications for the delivery of eye care for infants with ROP,” he added. “We can use information technology to get the most experienced ophthalmologists to examine babies, then develop systems for identifying babies with clinically significant disease that requires referral for further evaluation and potential treatment.”
Dr. Meenakashi Gupta, Co-director of Teleretinal Imaging at New York Eye and Ear Infirmary of Mount Sinai in New York City, said the study is “exciting, as it has the potential to expand diagnostic care for ROP into regions of the world that have had limited access.”
“The information obtained from digital images is different from that obtained from an in-person examination with a hand-held lens,” he said in an email to Reuters Health.
“Current widefield images often provide a limited and distorted view of disease in peripheral areas of the retina and do not provide the 3-dimensional details of the traditional binocular examination needed to highlight certain stages of disease,” he explained.
“Other aspects of disease are best seen in photographs,” he said. “Some cases may require both imaging and in-person examination.”
“Prior to widespread introduction of this technology, development of a novel diagnostic framework for ROP based on digital images will be needed,” he added.
“Telemedicine will not entirely replace traditional care, but will be an adjunct that provides the opportunity to review, improve and expand our current systems of clinical care,” Dr. Gupta concluded.
SOURCE: http://bit.ly/2JCty2F and http://bit.ly/2JHDHLt
JAMA Opthalmol 2018.
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