Implementation of telemedicine screening for retinopathy of prematurity in rural areas in Guatemala

PURPOSE To report findings of a telemedicine retinopathy of prematurity (ROP) screening program in six neonatal units in rural areas of Guatemala, using a portable, noncontact, 40 degrees field digital fundus camera (Pictor Plus) operated by trained technicians. METHODS National ROP Program Guidelines screening criteria were used: gestational age <36 weeks and/or birth weight (BW) <2000 g, or GA <36 weeks but BW >= 2000 g, with qualifying medical history. Retinal images were obtained by two technicians and graded by ophthalmologists experienced in ROP. Infants with signs of pre-plus or plus disease in one or both eyes were referred for clinical examination. Screening was stopped when retinal vessels in anterior zone II were normal on two successive evaluations or the infant had reached 45 week's postmenstrual age. RESULTS A total of 418 of 1,890 eligible infants (22.1%) were screened. Mean GA was 33.9 +/- 2.2 weeks (range, 27-36), and mean BW 1728.3 +/- 379.3 g (range, 840-2830 g). Thirty-three infants (8.6%) developed plus or pre-plus disease, and 19 (58%) underwent ophthalmologic examination. Fifteen infants were confirmed with type 1 ROP, and 14 were treated. Mean GA of treated infants treated was 33.6 +/- 3.0 weeks (range, 32-34.9), and mean BW was 1,646 +/- 245.8 g (range, 1100-1774.1 g). CONCLUSIONS Imaging with a noncontact fundus camera can facilitate detection of treatable ROP in countries with limited resources. Strengthening the health systems, including motivation and continued training of neonatal intensive care personnel is essential to improve and maintain program effectiveness. Reasons for, and interventions to address the low uptake of screening need to be explored to extend coverage of ROP screening to district hospitals in Guatemala.