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About Sickkids
About SickKids

October 29, 2014

SickKids ophthalmologist uses telemedicine to screen for serious eye disease

By Christine Wolfl

Dr. Nasrin Tehrani, Ophthalmologist at The Hospital for Sick Children (SickKids), has introduced telemedicine in the fight against a serious eye disease that can affect infants – retinopathy of prematurity (ROP).

She describes her work in an article, Using telemedicine to screen for retinopathy of prematurity, which was published in the Canadian Medical Association Journal in September 2014. For Tehrani, the article marks a path of progress that started in 2005 when she joined SickKids.

“When I first started at SickKids, the main obstacle to providing timely care for infants in remote locations was access to care. Some of these children were in ICUs far away from Toronto, and many of them were in places where there were no ophthalmologists who could screen for retinopathy of prematurity.”

Retinopathy of prematurity is a vascular proliferative disease of the retina affecting premature infants. Babies born weighing less than 1250 grams or under 30 weeks of gestation are routinely screened for the disease. Without proactive treatment, severe ROP can result in retinal detachment and permanent loss of vision.

The shortage of ophthalmologists trained to screen for ROP in regions outside the GTA meant that many premature infants were sent to SickKids, in some cases by airplane, ferry and ambulance. Inspired to eliminate these lengthy and potentially dangerous trips, Tehrani decided to look for a better process. In communicating with the nurses who transported the infants, she encouraged them to consider training in the use of a digital paediatric fundus camera, a wide-angle camera that permits photography of the peripheral retina. This would allow the health-care professionals to take pictures of the infant’s eye, then send them to Tehrani so she could assess whether the child would require a trip to SickKids.

In 2009, Tehrani founded the Ontario Telemedicine for Retinopathy of Prematurity project, using real-time communication. Two-way video during the screening allows guidance from the central reading site at SickKids. For a difficult procedure that requires a certain amount of practice, the opportunity for guidance and continuing education is invaluable.

“In Northern Ontario, there is a shortage of highly skilled NICU nurses. Taking the nurses away from their normal work environment to teach a new skill that is not a part of their routine would be disruptive to the functioning of the NICU,” she says. “These are babies that they are spending so much time, effort and energy to save. We found a way to bring our teaching and support to the nursing team in remote hospitals so they can continue with their NICU work while they learn to take images of the eye in the premature neonates. This allows everyone to function safely and effectively and allow us to continue to save sight for these precious infants.”

Former SickKids fellow Diego Ossandon has used the research to develop a similar retinopathy of prematurity program in Chile. In Ontario, two centres, in Sudbury and Barrie, are connected with SickKids, and a partnership has been established between McMaster University and an ICU in Grand River. A third centre is proposed for Orillia.

Telemedicine
Cynthia VandenHoven, medical imaging specialist, learns to screen for retinopathy of prematurity, using a digital paediatric fundus camera in a simulated setting. Instruction is provided by Dr. Nasrin Tehrani on the screen (right).