New tools aid in ROP

For infants at risk of developing retinopathy of prematurity (ROP), a new Internet-based remote disease management imaging system (FocusROP, Clarity Medical Systems) could be an important component of a 'safety net' for care.

The system includes hospital investment and support, special software to manage digital images, and parent and neonatal intensive care unit (NICU) staff education, according to Dr Michael T. Trese.

"ROP is the leading cause of blindness in premature infants. With proper treatment, there is a very high success rate, but the key to proper treatment is screening," remarked Dr Trese, chief of paediatric and adult vitreoretinal surgery, William Beaumont Hospital, Royal Oak, Michigan, USA. "In my opinion, and there is literature to back this up, the very best way to do screening is with photographs."

Hospitals that use the system purchase or lease a camera that obtains wide-angle, digital images of infants. Hospital personnel, typically NICU nurses, are trained and certified in the photographic technique and in using software and uploading to a designated website ( http://www.focusrop.com).

Handy capabilities, back up support

The system works with local physicians who perform screening at particular sites and provides training and credentials for networks of readers.

According to Dr Trese, the system contains an algorithm that incorporates the most conservative recommendations that have emerged from randomized, prospective clinical trials for ROP, including the proper screening interval for the clinical findings.

He also said that with the system, physicians can compare the weekly screening images side by side, which makes it easier to detect changes than with older methods such as bedside drawings. Neonatologists, nurses and parents can also easily see changes in the images, granting them more active participation than was possible before.

System complements traditional care

The system does not jettison traditional bedside examinations, which remain fundamental to ROP screening, Dr Trese emphasized. He explained that the algorithm will mandate that bedside examinations be performed based on certain findings in the digital images.

Parental participation and education is also is an important component of the system.

"One of the places where children fall through the cracks is between hospital examination and office-based examination, so there's a form that parents have to sign that says they realize that this screening is very important and if follow-up examinations are not performed, that the child is at risk of blindness," Dr Trese said.

Parents also are referred to the website of the Association for Retinopathy of Prematurity and Related Diseases ( http://www.ropard.org), which provides information for families as well as resources for healthcare providers.

"The parents are brought into the child's ROP care while the child is still in the NICU," Dr Trese explained. "[We hope] that will engender a better participation on the parents' part in terms of making sure the child receives the proper follow-up care.

"We think that by using this three-pronged approach, the child will receive better care and the doctors and hospitals will end up with some mitigation of malpractice risk," he continued, adding that the examiners who review images must undergo recertification by continuing medical education examination every 2 years.

The system was designed by Dr Antonio Capone Jr., Dr Kimberly Drenser, PhD, Dr Jay Federman and Dr Carl Park. It was introduced formally at the 2009 annual meeting of the American Academy of Ophthalmology. Response from neonatologists and ophthalmologists has been favourable, although there is some controversy among the latter speciality about photographic screening, Dr Trese commented.

In addition, he said that the system could be used in research studies as well as in clinical settings.

A web-based disease managament imaging system could enhance screening for retinopathy of prematurity through acquisition and reading of weekly digital retinal images, hospital support and more opportunities of parental involvement.