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Tele-matics of Digital Wide-angle Fundus Photography - A new Method for Improved Prevention of Blindness in Premature Children
Universität Regensburg, Klinik und Poliklinik für Augenheilkunde, Abt. für Pädiatrische Ophthalmologie, Strabismologie und Ophthalmogenetik (Regensburg)
Problem: Acute retinopathy of prematurity (ROP) is the main cause for severe visual impairment and blindness in premature children. Once stage 3+ is reached, the risk for retinal detachment and subsequent blindness is about 50% without therapy, and drops to only a few percent with timely laser therapy. A high degree of expertise with ROP is necessary to detect and evaluate the critical retinal changes. The actual screening programme does not detect all cases requiring therapy. Using a digital wide angle camera system and transmitting the images to an expert reading centre would seem to allow an improvement .
Material and Method: At present, a pilot study approved by the local ethical committee is conducted connecting 5 neonatal intensive care units (NICUs) in Eastern and Northern Bavaria with the Reading Centre at the University of Regensburg. Evaluated are the sensitivity, specificity, cost-effectiveness, power to develop new treatment modalities, and the interest to use digital imaging in all NICUs. All premature infants at risk for ROP are examined according to the actual Geman screening recommendations . Examination includes digital imaging with a wide angle fundus camera (RetCam120) and conventional indirect ophthalmoscopy. In the NICUs outside Regensburg the screening is performed by the local ophthalmologists. The images are stored locally and transmitted via 2 ISDN channels to the Reading Centre. The personal data are anonymised and transmitted via email or fax. The data are analysed with a specially developed software.
Results: 192 infants were screened within the first 12 months. All stages requiring treatment (7 children) were detected. Imaging of zone III (not requiring treatment according to international criteria) was not reliable under screening conditions. The correct interpretation of proliferative changes not only requires optimal imaging but also significant expertise with the ophthalmoscopic appearance. The present definition of zones appears imprecise. Objective analysis of the pathology in space and over time may help to develop new treatment criteria and modalities.
Conclusions: Telematics of digital wide angle fundus photography is an innovative method that allows to detect all ROP stages requiring treatment. Analysis of the images in a reading centre increases the reliability of the interpretation of the data and not only allows standardised treatment but has also the potential of a more sophisticated evaluation and (ophthalmological and/or neonatal) therapy.
Bayerische Landesstiftung, Bayerische Sparkassenstiftung, DFG Lo 457/4-1,2
Literatur: (1) Lorenz,B., Bock,M., Müller,H.M., Massie,N.A. (1999) Telemedicine based screening of infants at risk for retinopathy of prematurity. Stud.Health Technol.Inform. 64:155-63: 155-163. (2) Clemens,S., Eckardt,C., Gerding,H., Grote,A., Jandeck,C., Kellner,U., Lorenz,B., Petersen,J., Seiberth,V., Stärk,N., Ulbig,M.W., Zubcov,A., Jorch,G., Pohlandt,F. (1999) Augenärztliche Screening-Untersuchung von Frühgeborenen. Ophthalmologe. 96 (4): 257-263.