Parental perceptions toward digital imaging and telemedicine for retinopathy of prematurity management

  • Joo-Yeon Lee
  • Yunling E. Du
  • Osode Coki
  • John T. Flynn
  • Justin Starren
  • Michael F. Chiang



Telemedicine is an emerging technology with potential to improve care for retinopathy of prematurity (ROP). This study evaluates parental perceptions about digital imaging and telemedicine for ROP care.


During a 1-year period, one parent of each infant who underwent wide-field retinal imaging for ROP was given a questionnaire designed to evaluate parental perceptions using a 5-point Likert-type scale. Five items assessed perceptions toward digital retinal imaging, and ten items assessed attitudes toward telemedicine. Construct validity of the questionnaire was examined using factor analysis. Responses were summarized using descriptive and correlational statistics.


Forty-two parents participated. Factor analysis extracted two factors explaining 79% of the total variance in digital retinal imaging items (Cronbach’s alpha = 0.843), and three factors explaining 63% of the total variance in telemedicine items (Cronbach’s alpha = 0.631). Among digital imaging items, the highest mean (±SD) score was for “digital pictures of my child’s retinopathy should be included in the permanent medical record” (4.4 ± 0.6), and the lowest was for “digital cameras and computers are reliable” (3.8 ± 0.8). Among telemedicine items, the highest mean (±SD) score was for “technology will improve the quality of medical care for my child” (4.3 ± 0.6), and the lowest was for “technology will make it harder for a patient and doctor to establish a good relationship” (2.6 ± 1.1).


Parents reported positive perceptions about telemedical ROP diagnosis, but expressed some preference for face-to-face care. Telemedicine has potential to alter the nature of the patient–physician relationship.


Retinopathy of prematurity Retina Pediatric ophthalmology Telemedicine Medical informatics Survey 


  1. 1.
    Early Treatment for Retinopathy of Prematurity Cooperative Group (2003) Revised indications for the treatment of Retinopathy of Prematurity: Results of the Early Treatment for Retinopathy of Prematurity Randomized Trial. Arch Ophthalmol 121:1684–1694CrossRefPubMedGoogle Scholar
  2. 2.
    International Committee for the Classification of Retinopathy of Prematurity (2005) The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 123:991–999CrossRefGoogle Scholar
  3. 3.
    Munoz B, West SK (2002) Blindness and visual impairment in the Americas and the Caribbean. Br J Ophthalmol 86:498–504CrossRefPubMedGoogle Scholar
  4. 4.
    Steinkuller PG, Du L, Gilbert C, Foster A, Collins ML, Coats DK (1999) Childhood blindness. J AAPOS 3:26–32CrossRefPubMedGoogle Scholar
  5. 5.
    Hamilton BE, Martin JA, Ventura SJ (2006) Births: Preliminary data for 2005. Available at: Accessed November 1, 2008.
  6. 6.
    Gilbert C, Fielder A, Gordillo L, Quinn G, Semiglia R, Visintin P, Zin A (2005) International NO-ROP Group. Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: Implications for screening programs. Pediatrics 115:e518–e525CrossRefPubMedGoogle Scholar
  7. 7.
    American Academy of Ophthalmology (2006) Ophthalmologists warn of shortage in specialists who treat premature babies with blinding eye condition. Available at: Accessed June 28, 2008
  8. 8.
    Bashshur RL, Reardon TG, Shannon GW (2000) Telemedicine: A new health care delivery system. Annu Rev Public Health 21:613–637CrossRefPubMedGoogle Scholar
  9. 9.
    Ells AL, Holmes JM, Astle WF, Williams G, Leske DA, Fielden M, Uphill B, Jennett P, Hebert M (2003) Telemedicine approach to screening for severe retinopathy of prematurity: A pilot study. Ophthalmology 110:2113–2117CrossRefPubMedGoogle Scholar
  10. 10.
    Chiang MF, Keenan JD, Starren J, Du YE, Schiff WM, Barile GR, Li J, Johnson RA, Hess DJ, Flynn JT (2006) Accuracy and reliability of remote retinopathy of prematurity diagnosis. Arch Ophthalmol 124:322–327CrossRefPubMedGoogle Scholar
  11. 11.
    Chiang MF, Wang L, Busuioc M, Du YE, Chan P, Kane SA, Lee TC, Weissgold DJ, Berrocal AM, Coki O, Flynn JT, Starren J (2007) Telemedical retinopathy of prematurity diagnosis: accuracy, reliability, and image quality. Arch Ophthalmol 125:1531–1538CrossRefPubMedGoogle Scholar
  12. 12.
    Scott KE, Kim DY, Wang L, Kane SA, Coki O, Starren J, Flynn JT, Chiang MF (2008) Telemedical diagnosis of retinopathy of prematurity intraphysician agreement between ophthalmoscopic examination and image-based interpretation. Ophthalmology 115:1222–1228CrossRefPubMedGoogle Scholar
  13. 13.
    Chiang MF, Starren J, Du YE, Keenan JD, Schiff WM, Barile GR, Li J, Johnson RA, Hess DJ, Flynn JT (2006) Remote image-based retinopathy of prematurity diagnosis: a receiver operating characteristic (ROC) analysis of accuracy. Br J Ophthalmol 90:1292–1296CrossRefPubMedGoogle Scholar
  14. 14.
    Wu C, Peterson RA, Van der Veen DK (2006) RetCam imaging for retinopathy of prematurity screening. J AAPOS 10:107–111CrossRefPubMedGoogle Scholar
  15. 15.
    Murakami Y, Jain A, Silva RA, Lad EM, Silva RA, Gandhi J, Moshfeghi DM (2008) Stanford university network for diagnosis of retinopathy of prematurity (SUNDROP): 12-month experience with telemedicine screening. Br J Ophthalmol 92:1456–1460CrossRefPubMedGoogle Scholar
  16. 16.
    Silva RA, Murakami Y, Jain A, Gandhi J, Lad EM, Moshfeghi DM (2009) Stanford university network for diagnosis of retinopathy of prematurity (SUNDROP): 18-month experience with telemedicine screening. Graefes Arch Clin Exp Ophthalmol 247:129–136CrossRefPubMedGoogle Scholar
  17. 17.
    Lorenz B, Spasovska K, Elflein H, Schneider N (2009) Wide-field digital imaging based telemedicine for screening for acute retinopathy of prematurity (ROP). Six-year results of a multicentre field study. Graefes Arch Clin Exp Ophthalmol 247:1251–1262CrossRefPubMedGoogle Scholar
  18. 18.
    Jackson KM, Scott KE, Graff Zivin J, Bateman DA, Flynn JT, Keenan JD, Chiang MF (2008) Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management. Arch Ophthalmol 126:493–499CrossRefPubMedGoogle Scholar
  19. 19.
    Castillo-Riquelme MC, Lord J, Moseley MJ, Fielder AR, Haines L (2004) Cost-effectiveness of digital photographic screening for retinopathy of prematurity in the United Kingdom. Int J Technol Assess Health Care 20:201–213CrossRefPubMedGoogle Scholar
  20. 20.
    Field MJ, Grigsby J (2002) Telemedicine and remote patient monitoring. JAMA 288:423–425CrossRefPubMedGoogle Scholar
  21. 21.
    Mair F, Whitten PS (2000) Systematic review of studies of patient satisfaction with telemedicine. BMJ 7248:1517–1520CrossRefGoogle Scholar
  22. 22.
    Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL (2005) Role of computerized physician order entry systems in facilitating medication errors. JAMA 293:1197–1203CrossRefPubMedGoogle Scholar
  23. 23.
    Stone JH (2007) Communication between physicians and patients in the era of e-medicine. New Engl J Med 356:2451–2454CrossRefPubMedGoogle Scholar
  24. 24.
    Section on Ophthalmology American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus (2006) Screening examination of premature infants for retinopathy of prematurity. Pediatrics 117:572–576CrossRefGoogle Scholar
  25. 25.
    Bakken S, Grullon-Figueroa L, Izquierdo R, Lee NJ, Morin P, Palmas W, Teresi J, Weinstock RS, Shea S, Starren J, IDEATel Consortium (2006) Development, validation, and use of English and Spanish versions of the telemedicine satisfaction and usefulness questionnaire. J Am Med Inform Assoc 13:660–667CrossRefPubMedGoogle Scholar
  26. 26.
    Yip MP, Chang AM, Chan J, MacKenzie AE (2003) Development of the Telemedicine Satisfaction Questionnaire to evaluate patient satisfaction with telemedicine: a preliminary study. J Telemed Telecare 9:46–50CrossRefPubMedGoogle Scholar
  27. 27.
    Chiang MF, Jiang L, Gelman R, Du YE, Flynn JT (2007) Interexpert agreement of plus disease diagnosis in retinopathy of prematurity diagnosis. Arch Ophthalmol 125:875–880CrossRefPubMedGoogle Scholar
  28. 28.
    Reynolds JD, Dobson V, Quinn GE, Fielder AR, Palmer EA, Saunders RA, Hardy RJ, Phelps DL, Trese MT, Schaffer D, Tung B, CRYO-ROP Cooperative study Groups (2002) Evidence-based screening criteria for retinopathy of prematurity: natural history data from the CRYO-ROP and LIGHT-ROP studies. Arch Ophthalmol 120:1470–1476PubMedGoogle Scholar
  29. 29.
    Barrows RC, Clayton PD (1996) Privacy, confidentiality, and electronic medical records. J Am Med Inform Assoc 3:139–148PubMedGoogle Scholar
  30. 30.
    Hodge JG, Gostin LO, Jacobson PD (1999) Legal issues concerning electronic health information: privacy, quality, and liability. JAMA 282:1466–1471CrossRefPubMedGoogle Scholar
  31. 31.
    National Research Council (1997) For the record: protecting electronic health information. National Academy Press, WashingtonGoogle Scholar
  32. 32.
    Kohn LT, Corrigan JM, Donaldson MS (2000) To Err is Human: Building a Safer Health System. National Academy Press, Washington (DC). Available at: Accessed June 28, 2008.
  33. 33.
    Bates DW, Gawande AA (2003) Improving safety with information technology. N Engl J Med 348:2526–2534CrossRefPubMedGoogle Scholar
  34. 34.
    Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM, Burdick E, Hickey M, Kleefield S, Shea B, Vander Vliet M, Seger DL (1998) Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 280:1311–1316CrossRefPubMedGoogle Scholar
  35. 35.
    Bodenheimer T, Grumbach K (2003) Electronic technology: a spark to revitalize primary care? JAMA 290:259–264CrossRefPubMedGoogle Scholar
  36. 36.
    Baker L, Wagner TH, Singer S, Bundorf MK (2003) User of the Internet and e-mail for health care information: results from a national survey. JAMA 289:2400–2406CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Joo-Yeon Lee
    • 1
    • 2
  • Yunling E. Du
    • 3
  • Osode Coki
    • 1
  • John T. Flynn
    • 1
  • Justin Starren
    • 4
  • Michael F. Chiang
    • 1
    • 4
  1. 1.Department of OphthalmologyColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Department of OphthalmologyHallym University College of MedicineSeoulSouth Korea
  3. 3.Department of Epidemiology and Public HealthAlbert Einstein College of MedicineNew YorkUSA
  4. 4.Department of Biomedical InformaticsColumbia University College of Physicians and SurgeonsNew YorkUSA

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