A Report of Auckland Networked Telemedicine ROP screening

Zhen Wu BN, RN, Sharron Iverson BN, RN, Shuan Dai FRANCO

Purpose:
To report our experience of nurse-lead telemedicine Retinopathy of Prematurity (ROP) screening programme.

Methods:
Following confirmation of high sensitivity and specificity of RetCam wide field digital retinal imaging in ROP screening in our previous study, Retcam was adopted into our routine ROP screening program. Two ophthalmic nurses fully trained & accreditted by ophthalmologist specialized in ROP managenment, provided unsupervised ROP screening using Retcam Shuttle in two remote leve 2 NICUs. A minimal of 3 images (posterior pole, medial and lateral retina according to local protocol) were captured for each eye at every screening session. Patient images captured were uploaded to a Web-based telemedical review server at a tertiary center and images were graded by a pediatric ophthalmologist experienced in ROP screeening & Retcam imaging and followup screening time interval was determined.

Result:
59 infants (one hundred eighteen eyes) meeting the local ROP screening guidelines (GA<30weeks, BW<1250gram) were screened at 177 consecutive sessions between August 2008 and September 2009. A total of one thousand five hundred and four images obtained. The Mean gestation age was 28.09 weeks (range, 24 weeks six days to 32 weeks plus two days). The mean infant birth weight was 1063.40g (range, 710g to 1610g). All the images were adequate for the opthhalmologist to grade the severity of ROP. One infant had severe ROP (stage 3, zone2 with plus disease) was referred for laser treatment. The rest 58 infants had ROP staged 2 or less. There were no known complications occrred in the Retcam ROP screening

Conclusion:
Our experiences show that telemedicine ROP screening with retinal images taken by trained ophthalmic nurse, remotely graded by ophthalmologist experienced in ROP screening is safe and efficient.