Telemedicine (Wide-Field Digital Imaging – WDFI)
Approach to ROP Evaluation

The goal of screening infants for
retinopathy of prematurity is to, as
effectively as possible, identify children
requiring treatment. Ideally, each child
would have an “ROP expert” performing
screening exams—an impractical ideal if
the “expert” must be present in person
at the bedside. This goal can be attained,
however, by implementing a currently
available camera technology which
allows a digital image to be taken of an
infant’s retina, transmission of the image
to a centralized Reading Center and
evaluation by physicians with a high level
of expertise in ROP diagnosis.
The standard method of evaluating
infants has been to examine them at
the bedside with a headset of the sort
that the parents have seen physicians
use when their children are examined in
the offi ce. With this approach, the task
of screening all at-risk babies for ROP
via bedside exam poses something of
a manpower challenge. Furthermore,
many physicians don’t have extensive
experience with premature infants—
particularly those who are profoundly
premature. Such premature infants are
encountered with increasing frequency
as the physicians and staff in neonatal
intensive care units are increasingly
effective at keeping premature infants
both alive and well.
There has been some debate in the
community of ophthalmologists as to
whether evaluating infants with digital
imaging technology is as good as a “live”
exam performed at the infant’s bedside.
To address this question, a clinical
trial involving a variety of prominent
medical centers in the country, called
the Photo-ROP Study, was conducted
to compare these two methods of
diagnosis head-to-head. The Coordinating
Center and Reading Center for the
study were located on the campus of
William Beaumont Hospital in Royal
Oak, Michigan. Fifty-one infants were
followed for up to ten weeks with
serial digital retinal images taken on a
weekly basis. These were then sent to
the Reading Center and evaluated by a
physician experienced in the diagnosis
and management of retinopathy of
prematurity. These Reading Center
evaluations were compared to the opinion
of the bedside examiner.
The results of the study demonstrated
that the physicians interpreting the digital
fundus images in the Reading Center were
in nearly complete agreement with the
physicians examining the infants at the
bedside.
Now that effective therapies (such as
laser) exist, screening infants has assumed
the primary role in prevention of
blindness from retinopathy of prematurity.
The results of the Photo-ROP Study
demonstrated the utility of remote
imaging in ROP screening. Telemedicine
offers a potential solution to the
challenges in screening.


Fundraising Golf Events Across the
Country
In Texas, the Skipper Family hosted their Sixth Annual
Benefi t Golf Tournament. Inspired by nine-year old Kelsi
Skipper who has ROP, the fundraiser supports ROPARD
and Cook Children’s Medical Center in Fort Worth.
In Ohio, the Trinity Rose Foundation held its Third Annual
Golf Outing. Named after four-year-old Trinity Rose
who was born with familial exudative vitreoretinopathy
(FEVR), the Foundation held a successful event. True
to its objectives, donations were divided among three
recipients: the UDS Low Vision Services, (United
Disability Services), a program that provides low vision
assessment, adaptive aids, and educational services
to blind and visually impaired children; ROPARD for
medical research; and, seven-year-old Nathanial Brantley,
born legally blind due to a rare genetic birth defect, for
surgery to stop the onset of the disease.
In California, the McGovern family held a benefi t golf
tournament to honor their son, eleven-year-old Jack
McGovern, who has severe vision loss in his left eye from
Coats’ disease, a pediatric retinal disease. The money
raised has been donated to ROPARD for research into
the cause and therapy for Coats’ disease.
In Michigan, the annual golf tournament hosted by Ken
Bushway was another success, with the money raised
donated to ROPARD.
ROPARD wishes to thank all of the generous volunteers
and sponsors who have donated both time and money
for these events.
SMILES and SMILES in India
In 2007, Dr. Anand Vinekar, an Indian retinologist
interested in pediatric retinal diseases, spent six months
working with Dr. Michael Trese at Beaumont Hospital
in Royal Oak, Michigan. Infl uenced by what he learned
about ROPARD and the work done by Dr. Trese, he
developed plans to implement a similar program in India.
Upon his return to India Dr. Vinekar established the
“Pediatric Retinal Vision Research Foundation”. The
Foundation will work to bring telemedicine screening to
eleven neonatal intensive care units in Karnataka State
as a pilot project (population 52 million). The goal is to
provide state-of-the-art ROP screening to all of these
facilities.  In addition, a pediatric visual rehabilitation department
was started in Narayana Nethralaya Postgraduate
Institute of Ophthalmology. The department is fullyequipped
to care for visual rehabilitation needs of any
age group, beginning with preverbal children. A dedicated
pediatric visual rehabilitator has teamed up with the
Spastics Society for developmental rehabilitation, plus
occupational and physical therapists and pediatric
neurologists.
A one-week in-house rehabilitation program, called
SMILES, or a Steady Mile Toward Sight, was launched.
Under the program, the child and care-giver stay in the
new hospital and receive a different therapy each day
(art, music, language, etc.). On the last two days, the
child is assessed using the Oregon scale and is given a
customized set of activities and timetable to perform at
home. The cycle is repeated when the child returns two
months later for the SMILES-2 program.
ROPARD is honored

Anchor Center for Blind Children,
Denver, Colorado
Seeing a need for services for blind and visually impaired
children, Anchor Center for Blind Children was founded
in 1982 in Denver by the local Delta Gamma Alumni
chapter and a librarian from the Colorado Library
for the Blind. The fi rst children enrolled in the center
included four preschool students and six home bound
infants. Today, Anchor Center serves more than 400
children per year.
The Center’s mission is to teach visually impaired infants,
young children and their families. It provides hope and
a nurturing environment where children can reach their
highest potential.
The Anchor Center is a modern facility with qualifi ed
personnel. It provides educational and therapeutic
services to children, and the setting encourages the child
to function independently and to interact confi dently
with others. Families are provided with information
and support for the purposes of understanding their
child’s potential and learning to advocate for their child.
The Center also collaborates with local schools and
other community agencies to help the child operate
successfully within the community.

Cassie Bruno and “Volley for Vision”

On October 4, 2008 the
women’s Volleyball team
at Point Park University in
Pittsburgh, Pennsylvania,
hosted a match against
its American Midwest
Conference rival, Notre
Dame College. The event
was planned to increase
the team’s rank and as a
fundraising event to benefi t
ROPARD. It was organized
by the team’s head coach,
Mike Bruno, whose threeyear
old daughter, Cassie,
has limited vision as a result
of ROP.
Cassie, the daughter of Mike and his wife, Jennifer, was
born 15 weeks premature. The fi rst two months of her
life were a struggle for both Cassie and her family. With
so many medical problems in their tiny baby, the Brunos
did not think about her vision until just before it was
time to go home. Towards the end of their hospital stay,
the doctors had been checking her eyes weekly. Then,
after two weeks of good check-ups, she was diagnosed
with Stage 4 ROP with Plus Disease and immediately
treated with laser in an attempt to prevent scar tissue
from lifting the retina. This surgery was unsuccessful.
The Brunos moved Cassie to Children’s Hospital in
Pittsburgh where Dr. Karl Olsen performed a vitrectomy
and lensectomy on Cassie, one eye at a time. Upon
completion, he referred the Brunos to Dr. Trese.
Dr. Trese performed the ‘scrubbing bubble’ procedure,
where plasma from Jennifer’s blood was injected into
Cassie’s retina. The procedure
was successful in Cassie’s right
eye and her retina in that eye
remains fl at.
Cassie has been wearing a
contact lens on her right
eye for almost a year. It is
obvious, by changes in her
behavior, that it improves
her vision. However, what
and how much she can see
is diffi cult to assess until she can communicate better.
Due to her prematurity and vision loss, she is delayed in
some areas, one of which is speech. This is frustrating
for the family.
Cassie will begin preschool at the Western PA School for
Blind Children in December 2008. She loves music and
knows several songs, from the Jonas Brothers and the
Star Spangled Banner—she hums along and knows some
words. She enjoys bouncing on the trampoline, reading
her Braille books, and playing with her big sister, Carly.
While visiting Dr. Trese, the Brunos learned about the
ROP Support group and the Children’s Low Vision
Research Center where they contacted Paula Korelitz,
Outreach Director. Due to the generous assistance that
they received, the Brunos
decided to raise money to
enhance research sponsored
by ROPARD.
In 2007, Cassie’s Walk was
held and the proceeds were
donated to ROPARD. This
year, Mike Bruno’s volley
ball team became involved.
Fundraising activity and
charity work is encouraged
by the athletic department
of Point Park University, with
the students taking part in
many community activities.
The volley ball game was a
new format. Admission was a $5 donation for adults
and $2 for students. Additional donations could be
pledged for every “dig” (a defensive maneuver where
you control an attack (spike) from your opponent) that
Point Park achieved in the match or as a fl at fee. (Point
Park averages 50 digs per match.) All donations went to
ROPARD.
In the end, there were two winners: Point Park
University won the tournament, 3-1, and ROPARD
received the proceeds—over $3600. Obviously, Cassie
was an inspiration for everyone who attended.
Videos of the match can be seen at KDKA.com, search
Volley for Vision.