Retinopathy of Prematurity Study Cited as Promising mHealth Example

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At a recent U.S. Senate hearing, Francis Collins, MD, PhD, director of the National Institutes of Health, cited a project led by a CHOP researcher when discussing the promise held by mobile health (mHealth) applications. Children’s Hospital’s Graham E. Quinn, MD, MSCE, has been spearheading an innovative telemedicine project that could help prevent premature newborns from going blind.

Seen most often in preterm infants weighing 1250 grams or less, retinopathy of prematurity (ROP) is a condition in which growth of abnormal blood vessels in the eye can damage or even detach the retina, leading to severe vision loss and in some cases blindness. While most cases of ROP do not require treatment, roughly 10 percent do. Early detection is key in infants with severe ROP. The American Academy of Ophthalmology recommends screening by an experienced ophthalmologist for all infants who weight less than 3.3 pounds at birth or are born at or before 30 weeks.

Unfortunately, ophthalmologists experienced in detecting ROP are not always on hand when a preterm baby is born. The U.S. has seen a decline in ophthalmologists in recent years, with rural areas being most severely affected. In addition, some areas of the world where more preterm infants are surviving than ever before — such as Latin America and Eastern Europe, which also have a dearth of ophthalmologists — have higher rates of ROP-related blindness than the U.S.

Dr. Quinn’s project, however, offers a potential solution to this problem. He has been leading a collaboration among 13 North American clinical centers with neonatal intensive care. The e-ROP Cooperative Group has been investigating the feasibility of a remote telemedicine system to detect ROP in newborns.

Last year, Dr. Quinn and his team published the study results in JAMA Ophthalmology. They showed that trained non-physician evaluators who studied retinal images transmitted to computer screens at a remote reading center were able to identify infants who required specialized evaluation for ROP by an ophthalmologist.

“This study provides validation for a telemedicine approach to ROP screening and could help prevent thousands of premature babies from going blind,” said Dr. Quinn when the study was published. “Telemedicine potentially gives every hospital access to excellent ROP screening.”

Meanwhile, On the Hill

The e-ROP Cooperative’s work was raised during a recent meeting of the U.S. Senate Appropriations Committee’s Labor, Health and Human Services, Education, and Related Agencies Subcommittee. The NIH’s Dr. Collins was on Capitol Hill to discuss his agency’s budget, and during the course of the meeting Senator Brian Schatz of Hawaii brought up his own interest in telehealth, and asked Dr. Collins to talk briefly about the NIH’s telemedicine work.

While many of NIH’s institutes are working on telemedicine projects, a more recent, “very promising” area of research is mHealth, which takes advantage of mobile technologies, Dr. Collins noted. mHealth makes health “transportable, where people are walking around with their own potential telehealth gadgets in their pockets,” he said.

He then went on to briefly describe the e-ROP project, which he said uses technology in intensive care units to assess whether newborns have ROP, “by basically taking photographs, and then sending them to an expert across the country, to say this baby needs treatment, that one doesn’t.”

“Our NIH portfolio has shifted dramatically in the direction of mHealth, mobile health, using cellphone technology,” continued Dr. Collins, who added that mHealth “is bursting with potential for … maintaining health or for perhaps using this to monitor chronic illness … that’s such a great opportunity for medicine.”

Since the publication of the e-ROP study in JAMA Ophthalmology last year, Dr. Quinn has hardly rested on his laurels. In addition to his work as an attending surgeon in the Division of Ophthalmology, Dr. Quinn and his team have published a series of ROP-related papers, including two more in JAMA Ophthalmology. In March he co-authored a study on the development of a prediction model of ROP, and in June contributed to another on a centralized system for grading digital images of ROP.

The e-ROP Collective’s results “suggest that telemedicine could improve detection and treatment of ROP for millions of at-risk babies worldwide who lack immediate in-person access to an ophthalmologist,” said Eleanor Schron, PhD, RN, of the National Eye Institute, which has been supporting Dr. Quinn’s research.

To learn more about ophthalmology care and research at The Children’s Hospital of Philadelphia, see the Division of Ophthalmology website.

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