“Here’s looking at you kid”

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The Provincial Maternal Newborn Retinopathy of Prematurity (ROP) Remote Screening Work Group – a Work Group of the Provincial Council for Maternal and Child Health (PCMCH), recommended that a pilot project be initiated to investigate the feasibility of Registered Nurses performing remote eye exam screening for ROP via telemedicine. The Project was initiated in December 2008 between the Hôpital Regional Sudbury Regional Hospital (HRSRH) and Toronto’s Hospital for Sick Children (SickKids) Ophthalmology Department and is funded by the Ministry of Health and Long-term Care.

Retinopathy of Prematurity is a disease specific to premature babies. Retinopathy of prematurity is disruption of normal growth of blood vessels in the retina and if severe may progress to retinal detachment and blindness. Infants with a birth weight below 1500 grams or born at 30 weeks gestational age or less (North American Guidelines) are at risk of developing ROP. ROP screening facilitates detection of the disease in its earlier stages, can be treated and can prevent blindness.

Two NICU (advanced level II nursery) nurses were trained via videoconferencing during live exams under the guidance of an ophthalmologist. Telemedicine platforms, Retinal camera (RetcamTM), two NICU/Pediatric nurses, a pediatric ophthalmologist, a very supportive group of Pediatricians (two of which were trained to take Retcam images) and two incredible multidisciplinary teams from both sites come together to provide remote screening for ROP (Retinopathy of Prematurity).

Two registered nurses at Hôpital Regional Sudbury Regional Hospital in Sudbury,Ontario in a regional level II nursery (remote site) trained to obtain digital images of the retina following standardized protocol and scheduling criteria, for the purpose or ROP screening began their training by learning to use a digital wide angled retinal camera (Retcam) on a “trainer eye”, making a visit to SickKids to observe and taking a basic telemedicine tutorial. The “hands on” training occurred during imaging with real time interaction through a secure video connection via the Telehealth network between SickKids pediatric ophthalmologist, Dr. Nasrin Tehrani and the Sudbury site. Images obtained were then uploaded to a secure file transfer program (SFTP) and forwarded to be reviewed by the ophthalmologist at the reading center. A formal report is then faxed back to the remote site. According to ROP classification and criteria some infants may require weekly exams. Follow up with Dr. Tehrani at SickKids Eye Clinic is arranged once the infant is discharged.

Remote screenings for ROP utilizing telemedicine strategies can bring infants closer to their family’s home, help prevent inter-hospital transfers for these fragile neonates as well as continue to screen for development of ROP. The infants in our series did not develop severe ROP requiring referral to a reading centre. Video connection between the two sites for real-time interaction allowed personnel without previous imaging experience to acquire images with sufficient quality for appropriate assessment. Over the last 18 months, 32 infants have undergone screening for ROP. Fifty-five separate examinations were performed. No infant developed severe ROP to warrant referral to the reading centre, therefore avoiding 55 separate transfers (about 370 km one way) between the two sites. Two new remote sites are joining the project – Royal Victoria Hospital in Barrie and Grand River Hospital in Kitchener-Waterloo as well as one new reading site at Hamilton Health Sciences Centre, Hamilton.

Parent surveys revealed positive feedback. “I was able to be closer to my other children. I know how hard travelling would be on my baby.” Remote telemedicine screening has allowed infants and their families to return or remain closer to their communities, reduced travel, saved dollars for both the health care system and the infants’ family members.