Eyeworld

EW IN OTHER NEWS 62 December 2011 going to cut it. It gave the Armeni- ans the fundamental tools needed to treat ROP, but they still needed some guidance. Along with Michael F. Chiang, M.D., professor of ophthal- mology and medical informatics, Oregon Health & Science University, Portland, the team developed a training program using retcams and telemedicine, allowing them to mentor the Armenians from afar. "What we've shown in pub- lished research studies is you can train neonatal nurses to use retcams to take good pictures of the retina," said Dr. Chiang. "In fact, we've had some examples where we can get a more accurate diagnosis because the person who did the real eye exam missed a finding that showed up in the photograph. Babies wiggle around and sometimes you just miss things during ophthalmoscopy." As part of the program, Armen- ian doctors examined the infants themselves, wrote down their diag- nosis and recommendation for fol- low-up exams or treatment, and entered it into an online database. They then took a photo of the ba- bies' eyes using the retcam and up- loaded it on a companion online account, which handles photo- graphs. "They sent us a notification, we reviewed their retcam photos, and then correlated that to what they wrote down on the spreadsheet," ex- plained Dr. Lee. "That way we pro- vided direct oversight for the training, education, and manage- ment of these kids. What this al- lowed us to do is perform weekly rounding on their patients from our home countries as if we were physi- cally there. It's a really effective teaching platform." The supervision didn't stop with the diagnosis. The team also had the doctors photograph and upload the pre- and post-op laser images so they could comment on the effectiveness of the ROP treatment. The program lasted for a year, from June 2010 to June 2011. "We've done more than 500 su- pervised exams on more than 180 patients just in the first 6 months," said Dr. Lee. "Probably 30 children were treated, and that's 30 kids who I guarantee you would have been ab- solutely blind. So even within this short period of time, we've already exceeded our expectations for the impact it would have." Furthermore, as part of the proj- ect, AECP was very realistic about the issues surrounding a sustainable ROP initiative in a foreign country and worked to get Armenia's Min- istry of Health involved. Dr. Lee put together an economic model that calculated how much it would cost the government to screen a child versus how much it would cost to care for a blind child into adult- hood. "The Ministry of Health agreed that if AECP agreed to pay the ROP screeners for the first 2 years, the government would go ahead and fund the screening from that point forward," Dr. Lee said. "We knew when we left that these doctors would be compensated for their time and that screening would con- tinue. It wouldn't be a wasted effort, and that was critically important." The future The team is incredibly pleased with how well the Armenians are master- ing ROP diagnosis and treatment. The telemedicine program has been so successful, in fact, that the group would like to take the model to other countries. "What we're doing is not just focused on Armenia," said Dr. Chan. "We're working with partners to im- plement education programs glob- ally. We are trying to do assessments of programs that already have some sort of infrastructure, may have an ROP leader in their country, but just need more education." As for Armenia specifically, Dr. Ohanesian and the team returned in June to do an assessment of how things were going. AECP also plans on developing full telemedicine con- ferences to cover other aspects of ophthalmology as well. "At this point, if someone were to ask me when I retire what my biggest contribution to ophthalmol- ogy was, I would have originally said my lab work," said Dr. Lee. "But it's pretty clear to me now that this project will be the capstone of my career. How often is it that you can have an impact on an entire country done 3 days in country and 1 year looking at your computer screen?" EW Editors' note: The doctors mentioned have no financial interests related to this article. Dr. Chiang is an unpaid member of the Scientific Advisory Board of Clarity Medical Systems (Pleasanton, Calif.). Contact information Chan: rvpchan@gmail.com Chiang: chiangm@ohsu.edu Lee: thlee@chla.usc.edu Ohanesian: rogerohanesian@gmail.com Index to Advertisers Alcon Laboratories Inc. Page: 15 and 16 Phone: 800-862-5266 Fax: 800-241-0677 www.alconlabs.com Asia Pacific Page: 23 Phone: 65-63278630 www.apacrs.org BRACRS Page: 36 Phone: 55(17) 3214-5900 Fax: 55(17) 3214-5905 www.bracrs.org DGH Technology Inc. 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Page: 11 Phone: 813-885-5050 Fax: 813-885-9346 www.rheinmedical.com Ziemer Ophthalmic Page: 13 Phone: 866-708-4490 Fax: 681-462-9302 www.ziemergroup.com ASCRS•ASOA Meeting Information 2012 ASCRS Symposium and ASOA Congress Page: 10 ASCRS Cornea Day 2012 Page: 19 ASCRS Glaucoma Day 2012 Page: 27 ASCRS Winter Update 2012 Page: 40 and 41 ASCRS Membership Page: 33, 35, and 37 EyeWorld Corporate Mornings 2012 Page: 47 No continued from page 61 erally blind for unknown reasons. They decided that the one thing they all had in common was prema- turity." In the 10 years that Armenia had NICUs, not one child was screened for ROP. In the U.S., for ex- ample, one in 10 children in a NICU with regulated oxygen that does everything perfectly will develop se- vere ROP leading to blindness. But in developing countries where care might not be as good, that incident is much higher. "You couple that with no screening, and it's no surprise that one in every five children in Arme- nia was going blind in a NICU," said Dr. Lee. "You take that out over 10 years and that's a substantial num- ber of kids. [Doctors there] never saw ROP in their training. They weren't familiar with how to diagno- sis it, and they certainly weren't pre- pared to treat it. It's one thing to read about it in a book, and it's an- other thing to actually know how to treat it." "You try to take the things that are in the inbox," said Dr. Ohanesian. "The Armenians told me they had an issue with ROP, but I didn't realize it was as big a problem as it was. When I first went over there, there was an increasing wave of blindness from cataract, glau- coma, and retinal disease. They had no treatment for any of these things. Plus we had injured people. Kids will often find a landmine and play with it. There is so much of this. We took the most egregious issues first." Training from afar After Drs. Lee, Ohanesian, Chan, and Smith assessed the ROP situa- tion in June 2010, it became clear that a 3-day workshop just wasn't

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