Diagnosing Kids at Risk of Blindness: Instead of Logging Miles, Doctor Logs on; New Telemedicine Application Detects Eye Condition in Preemies More Quickly, Accurately.

PALO ALTO, Calif. -- Darius Moshfeghi, MD, pediatric retina specialist at Lucile Packard Children's Hospital, drives hundreds of miles each week around the Bay Area to personally examine premature infants at risk of blindness. But a budding telemedicine network at Packard Children's is allowing him to swap his steering wheel for a computer keyboard and help even more infants in the process.

"There are so many unmet medical needs," said Moshfeghi. "I had no time; I was driving on nights and on weekends, and I was always running late. Now I can devote myself exclusively to diagnosis. I can leverage my time and evaluate even more kids."

Moshfeghi is one of only a few physicians in the Bay Area trained to diagnose retinopathy of prematurity, or ROP -- a condition caused by an overgrowth of blood vessels in the retina. If recognized in the early stages, the condition can be successfully treated with laser surgery. If not treated in time the infants may go blind.

Until recently, the only way for Moshfeghi to examine a child was to go to one of several outlying hospitals and look in the infant's eye himself with an indirect ophthalmoscope. He would then take notes and draw pictures to use as a benchmark for future examinations of that child. With the new Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP), Moshfeghi can now obtain and view computerized images of the retina of a child in Santa Cruz, for example, without leaving his desk at Packard Children's. What took hours out of his day before now takes minutes.

The new network is the first-of-its-type at an academic center in the U.S. and it arrives at a critical time. Growing numbers of at-risk premature infants in this country -- about 60,000 last year alone -- coupled with more inclusive recommendations for screening are bringing pressure on Moshfeghi and his select group of colleagues. New guidelines implemented in February 2006 recommended ROP screening for any child born at 32 weeks of gestation or less, or weighing less than 1500 grams. Children with borderline results need to be re-screened repeatedly until a definitive diagnosis can be made.

The cornerstone of the network is an imaging system called the RetCam II, by Clarity Medical Systems, Inc. The RetCam II consists of a hand-held fiber optic camera connected to a wheeled console with a control panel and color video monitor. Physicians or nurses who have been trained on the RetCam II can quickly and safely scan an infant's eye in about five minutes. The digital image files are then sent to Moshfeghi for analysis. Real-time imaging is also a future possibility, allowing Moshfeghi to observe the scan as it happens, and ask for adjustments in focusing, angle or lighting during the imaging. Images generated by the RetCam II can also be printed out or saved for future reference by Moshfeghi or one of his colleagues.

"It's now possible to save a longitudinal history of the baby and more accurately track the progression of the disease," said Moshfeghi. A pictorial history also increases the chance of a timely and accurate diagnosis. A prospective, multi-center study called the PhotoROP trial reported in June of 2005 that users of the RetCam Digital Imaging System recommended intervention an average of two weeks earlier than did physicians performing bedside eye examinations, without missing any cases.

"If you consider a human being directly examining the eye to be the gold standard," said Moshfeghi, "the RetCam Digital Imaging System had 100 percent sensitivity and 97 percent specificity in the PhotoROP trial. This means that it identified all the referral-warranted disease all of the time, and that only three percent of the time did it suggest disease in healthy eyes."

The network consists of five RetCam units: one to stay at Packard Children's, and one each at neonatal intensive care units at Washington Hospital in Fremont, Sequoia Hospital in Redwood City, Dominican Hospital in Santa Cruz, and Valley Medical Center in San Jose.

"I'm very enthusiastic about the new network," said Moshfeghi, who is also an assistant professor of ophthalmology at the Stanford University School of Medicine. "It will allow me to sit back and objectively look at many more images than before. It's becoming clear that remote imaging systems like this one are the future of ROP screening."

For the media

Video, photos and a demonstration of this technology, 4/6/06 from 1p-2p and 4/11/06 from 3p-4p, Packard Children's, 725 Welch Rd., Palo Alto, CA. (space limited)

Photos are at http://www.lpch.org/newsEvents/NewsReleases/2006/moshfeghi.html.

Review the new American Academy of Pediatrics and American Academy of Ophthalmology guidelines for eye disease screening in premature infants at http://www.claritymsi.com/index/ropguide.html.