In this article, Dr Vinekar describes the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) programme and how this is changing the landscape of eye screening in India.
While overall medical services have improved, screening for ROP has not followed suit, particularly outside of large urban areas. This is compounded by the fact that 69% of India's 1.2 billion inhabitants live in rural communities.2 The only way to decrease ROP blindness, one of the most common causes of vision loss in childhood , is to go to the rural areas and screen the babies before they leave the NICU. When the RetCam Shuttle, a portable version of the widefield digital imaging system (Clarity MSI, California, USA) launched in 2007, a means to a solution was available.
The KIDROP model
A specialist team is then assigned to visit one regional headquarters each day. The specialist team consists of one project manager and one to two technicians. The project manager, typically a graduate of a master's of business administration programme (MBA), manages the programme and schedules all the visits, including counselling and contacting the remote mothers and encouraging them to participate in the follow-up. The technicians optimally have some experience with optometry, but it is not required. Both the project manager and the technician are extensively trained at the base hospital before they are deployed to the local zones.
The project manager and technicians start imaging on mannequins and then move on to live infants. Between 1200 and 1400 infants are imaged at the NN institute each month, providing significant exposure and practice for the trainees. The specialist teams are not only taught to acquire images with the RetCam, but also to diagnose the disease, separating the infants into one of three categories.5 A green rating is given to all infants that are completely disease free, with a mature retina and can be discharged without further follow-up. An orange rating indicates that there is some questionable pathology (i.e., Type 2 ROP, that would merit follow-up), where the child would be imaged again within a designated time period. A red rating is an urgent reference (i.e., Type 1 ROP, typically requiring treatment), and those babies must be seen and treated within 48 hours.6
All of these images and technician-assigned ratings are monitored via the cell phones, tablet devices or personal computers of paediatric retina specialists with expertise in ROP from the NN Institute in Bangalore using an indigenously developed tele-ROP platform.4,6 Once the technician is very proficient at imaging and rating infants, only random samplings of the images continue to be reviewed. When treatment is required, the KIDROP team mobilizes the expert to the regional center within 48 hours of detection, so that the baby does not have to be transported to the city. In the long-term, it is desirable to have local specialists who could treat the disease and efforts towards this are ongoing.
The KIDROP programme has now grown to cover more than 65% of the state of Karnataka, with mobile screenings occurring in 81 hospitals. In the five plus years since the inception of KIDROP, over 32??000 imaging sessions for over 8000 babies have been completed and more than 830 infants have received laser treatment for ROP, preventing them from irreversible blindness.7