Eyeworld

EW INTERNATIONAL 64 July 2015 by Matt Young and Gloria D. Gamat EyeWorld Contributing Writers started with the Armenian Eye Care Project in the country of Armenia [in 2009], which was just starting to build these neonatal intensive care units without fully understanding how to take care of some of the chil- dren when they got old enough and survived to get this disease, retinop- athy of prematurity." Armenian ophthalmologists, who were inexperienced in dealing with ROP when the project started, were as fully proficient in skills as their U.S. counterparts after 1 year of training. Since then, Dr. Lee has been training ophthalmologists from developing countries through Skype in not only how to screen ROP using mobile retinal cameras and the power of telemedicine but also how to treat the condition. Dr. Lee's efforts in telemedicine and ROP are getting an additional charitable awareness and celebrity push. In 2014, the Apl.de.ap Founda- tion International partnered with Children's Hospital Los Angeles, the PAO, and Western Union to intro- duce Apl of My Eye, a campaign for children in the Philippines. This campaign aims to address the issue of ROP in the country and to better equip and train doctors in the treat- ment of this condition. Through this campaign, Apl.de.ap, of the internationally recognized group Black Eyed Peas and founder of Apl. de.ap Foundation International, is paying homage to his roots in the Philippines. What is the future of retinal imaging cameras? These devices are going more compact, more mobile and with more improved features. "There will be more image pro- cessing capabilities, additional GUI enhancements, new high dynamic range cameras, with future product development pathway that includes smaller and lighter wireless camer- as," Dr. Linder said. EW Editors' note: Dr. Linder has financial interests with Clarity Medical Systems. Contact information Linder: blinder@claritymsi.com 10 medical practitioners in each of the 4 pilot facilities will save prema- ture babies from visual impairment. Through the ROPWG training of screeners, proficiency in using the indirect ophthalmoscope will lead to correct ROP diagnosis and appropri- ate management for these babies. The RetCam can augment the learn- ing process by documenting the pro- gression/regression of the disease. It will also aid in patient/parent and staff education about ROP. The ROPWG, along with the American Academy of Pediatric Section on Ophthalmology, the American Academy of Ophthalmol- ogy, and the American Association of Certified Orthoptists, believes that binocular indirect ophthalmo- scopy remains the gold standard for performing an ROP fundus evalua- tion. Remote digital fundus imaging (RDFI) evaluation does not replace a correctly performed binocular indirect ophthalmoscopy for ROP evaluation. The current goal of the ROPWG is to train more ophthal- mologists who can screen correctly with a binocular indirect ophthal- moscope. RDFI, however, can identify patients with clinically significant or referral-warranted ROP that will require further ophthalmic evalua- tion and management (level II and III evidence). Advantages include the potential to include RDFI images in electronic health records, objec- tively assess the quality of evalua- tions, increase the number of infants evaluated, improve parent and staff education, and fortify disease sur- veillance. At present, RDFI disadvan- tages include: the prohibitive cost; the images contain considerably less information than required to correctly stage the extent of ROP; clinical and cost effectiveness has not been studied; and the lack of a standard validated protocol and satisfactory performance standard for ROP evaluation. Case study: Armenia Hope that the program will succeed may lie in Armenia. Thomas C. Lee, MD, pediatric ophthalmologist and head of the Vision Center at Children's Hospital Los Angeles, told the Philippine Daily Inquirer in a recent interview: "We Working Group (ROPWG), headed by Pearl Tamesis-Villalon, MD, a retina specialist in the Philippines. The objectives of the ROP Working Group are to (1) increase awareness of ROP; (2) update the existing local joint statement on ROP screening and treatment; and (3) launch a na- tionwide training program for ROP screeners and establish a referral net- work in every region of the country. The Philippines is home to 15 children blinded by ROP out of every 179 blind children. This data was based on the 2005 Blind School Study, which investigated the pro- portion of childhood blindness as a result of ROP. The country is experiencing rapid improvement in neonatal care and an increasing survival rate of preterm infants, which leads to a larger number of potential ROP patients. Among the 1,600 ophthal- mologists in the different regions of the country, there are 105 doctors (66 retina specialists and 39 pedi- atric ophthalmologists) who can diagnose and treat ROP. But many of these specialists re- side and practice in the metropolis; only a handful are out there in the countryside. Enter the RetCam 3, an ergo- nomic, mobile, handheld retinal camera capable of using fundus an- giography (FA) that has a 130-degree wide field for imaging in the small eyes of premature and full-term babies. Add in RCRS, and you have a unique ophthalmology telemedicine tool. "Telemedicine is also enabled since a doctor is no longer required to be present at the NICU," said Barry Linder, MD, chief medical officer of Clarity Medical Systems. "A nurse or qualified technician can acquire the images and send them to an expert for interpretation. RCRS then allows clinicians to review Ret- Cam images in a secure web-based network. "If not managed carefully, ROP can progress extremely rapidly," Dr. Linder said. Four RetCam pilot facilities are underway in the Philippines thanks to collective fundraising. The Ret- Cam and telemedicine capabilities will augment the training of local ROP screeners. Training at least 6 to Retinal imaging is saving babies from blindness in developing countries and ushering in technological advancement T elemedicine is a hot topic but often discussed as more of a medical future in oph- thalmology than a current reality. Babies, however, appear to be bringing telemedicine from tomor- row to now. Two years ago, an EyeWorld arti- cle noted how the RetCam 3 (Clarity Medical Systems, Pleasanton, Calif.) was being used in Asia to detect eye abnormalities in newborns quickly— in one case, the earliest retinoblas- toma ever recorded in China. The article also noted that staff in rural China could capture digital fundus images of newborns and send them to eyecare hubs for analysis by a specialist. Fast forward to now, and the RetCam has a whole new spin on the notion of "send." The RetCam Review Software (RCRS) provides secure, remote access to RetCam images globally. A "one touch sync" allows images to synchronize across various computer sites to be viewed and interacted with anywhere—kind of like iTunes, but more secure and medical. Essentially, RCRS can acquire images from individual RetCams and provide the data to robust servers, such that even large scale remote image evaluation by or for an entire organization is made easy. Because of this and other innovators and philanthropists, developing countries like the Philip- pines, with improving Internet and technological infrastructure, are now able to support advances in pediatric eyecare. In the Philippines The Philippine Academy of Oph- thalmology (PAO) stands on the directive that early detection is the key to managing cases of retinop- athy of prematurity (ROP) in the country. Thus, the PAO together with the Philippine Pediatric Society and Philippine Society for Pediatric Newborn Medicine created the ROP The baby factor in ophthalmic telemedicine

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