printable versionDiagnosing kids at risk of blindness: Instead of logging miles, doctor logs on
BY KRISTA CONGER
Darius Moshfeghi looks for the telltale signs of a blinding disease in a premature infant at Packard Children’s.
Darius Moshfeghi, MD, used to drive hundreds of miles around the Bay Area each week to examine premature infants at risk of blindness. But lately the pediatric retina specialist at Lucile Packard Children's Hospital has been able to swap his steering wheel for a computer keyboard—and help even more infants in the process.
"I had no time," said Moshfeghi, who is also an assistant professor of ophthalmology. "I was driving on nights and on weekends, and I was always running late. Now I can devote myself exclusively to diagnosis."
Moshfeghi is one of only a few physicians in the Bay Area trained to diagnose retinopathy of prematurity, or ROP—a condition caused by an overgrowth of blood vessels in the retina. If recognized in the early stages, the condition can be successfully treated with laser surgery. But if not treated in time the infants will go blind.
Growing numbers of at-risk premature infants in this country—about 60,000 last year alone—coupled with more inclusive recommendations for screening are bringing pressure to bear on Moshfeghi and his select group of colleagues. New guidelines implemented in February recommend screening any child born at 32 weeks of gestation or less, or weighing less than 1,500 grams. Children with borderline results need to be re-screened repeatedly until a definitive diagnosis can be made.
Until recently, the only way for Moshfeghi to examine a child was to go to one of Packard Children's several satellite neonatal intensive care nurseries and look in the infant's eye with an indirect ophthalmoscope. He would take notes and draw pictures to use as a benchmark for that child's future examinations.
But now with the new Stanford University Network for Diagnosis of Retinopathy of Prematurity, Moshfeghi can obtain and view computerized images of the retina of a child in Santa Cruz, for example, without leaving his desk at Packard Children's. What took hours out of his day before now takes minutes.
The cornerstone of the network is an imaging system called the RetCam II, sold by Clarity Medical Systems Inc. It consists of a handheld fiber optic camera connected to a wheeled console with a control panel and color video monitor. Physicians or nurses who have been trained on the RetCam II can scan an infant's eye in about five minutes. The digital image files are then sent to Moshfeghi for analysis. Furthermore, the images can be printed out or saved electronically for future reference.
"It's now possible to save a longitudinal history of the baby and more accurately track the progression of the disease," said Moshfeghi. "If I go on vacation I no longer have to find someone who can read my mind or decipher my notes about each baby." A pictorial history also increases the chance of a timely and accurate diagnosis.
Packard Children's has purchased four cameras: one to stay at Packard Children's, and one each for its satellite neonatal intensive care units at Washington Hospital in Fremont, Sequoia Hospital in Redwood City and Dominican Hospital in Santa Cruz.
A prospective, multicenter study reported in June found that users of the RetCam Digital Imaging System recommended intervention an average of two weeks earlier than did physicians performing bedside eye examinations, without missing any cases.
Said Moshfeghi: "If you consider a human being directly examining the eye to be the gold standard, the RetCam Digital Imaging System had a 100 percent sensitivity and 97 percent specificity in the PhotoROP trial. This means that it identified all the referral-warranted disease all of the time, and that only three percent of the time did it suggest disease in healthy eyes."