Eye spy an Australian hospital first

In an Australian first, Mater Mothers’ Hospitals (MMH) neonatal nurses are conducting retinal photography on premature babies for ophthalmic examinations.

MMH—which care for approximately 2000 premature or seriously ill babies through the Neonatal Critical Care Unit each year—have spearheaded the program to enhance patient care.

Premature delivery interrupts normal retina development and vascularisation, which can lead to a condition called Retinopathy of Prematurity (ROP).

Approximately one third of babies born at less than 1500 grams and almost half of babies born at less than 1000 grams develop some degree of ROP. At present ROP cannot be prevented. With increasing survival of premature babies it is becoming more common.

The initiative has been developed by Mater’s neonatal and ophthalmology team, and is led by Dr Michael Forrest.

“The only way that ROP can be identified and assessed is by examining the retina, either with indirect ophthalmoscopy or by digital imaging using a RetCam™,” Dr Forrest said.

“Early detection is essential so that intervention can prevent blindness.

“With a shortage of paediatric ophthalmologists, and an increase in their workload, it is hoped that this extension of neonatal nursing clinical practice will have considerable impact on the provision of care to premature babies, and allow the screening program to be maintained.”

The need for ROP screening has increased significantly in recent years with the adoption of more stringent requirements for surveillance of very preterm babies and the lowering of treatment thresholds.

Routine eye examinations are carried out at Mater’s Neonatal Critical Care Unit for babies who have a low birth weight (less than 1250 grams) or are born prematurely (less than 31 weeks gestation).

ROP is rarely detected before 32 weeks gestation, so the window for screening is between 32 and 40 weeks, with the period between 34 and 37 weeks considered a critical period of disease progression and initiation of treatment.

Previously, all examinations at MMH were undertaken once a week by an ophthalmologist. Some regional centres do not offer this service so babies are transferred back to the tertiary facility for eye examinations—this places additional pressure on the limited availability of specialists in this field and the ambulance services transporting the babies between facilities.

MMH Deputy Director of Neonatology, Lynne Elliot said, “selected neonatal nurses at Mater Mothers’ have undergone clinical training under the direct supervision of Dr Forrest to learn how to capture digital images of the retina, which he then reviews”.

RetCam™ is imaging technology whereby digital images of the eye can be taken at the cotside.

These images do not need to be taken by an ophthalmologist as the data is stored and can be viewed after the examination. The retinal camera was purchased with a Queensland Health grant, made possible by an initiative of the Aspley Lions Club.

It is hoped that once the program is established and further funding obtained, future planning will incorporate portable RetCam™ screening and routine travel of neonatal nurses to regional centres.