Statewide Retcam Network - video transcript
Dr Shuan Dai
I'm Dr. Shuan Dai, the Director of Ophthalmology for Children's Health Queensland Hospital and Health Service and Queensland Children's Hospital. We're based in Brisbane, but we provide a statewide tertiary complex eye care for all children and young people across our states. The Retcam service really is predominantly used for screening for premature babies' retinas. So we pick up those early changes which might require some treatment. To screen those babies is quite labor intensive. And not so many ophthalmologists actually with the special skills can provide such services. In the best of times even in city like Brisbane, we tend to struggle to actually provide regular services and I think our regional centres this become very challenging, even in the best times. We have this telehealth network, in Queensland. Clinicians in this situation, most newly to nursing teams, they will capture the image and they will upload an image through the telehealth portal and I will be able to access or my colleagues from here we'll be able to access those images online in Brisbane, and we can provide almost real time diagnostic recommendation for them. For example, when a baby's retina shows this very tortured vessels with these bleeding rates, they will really require treatment.
Dr Mary Ghazawy
Welcome, guys, we're at the Townsville University Hospital Neonatal Care, which covers intensive and special care nurseries. And my name is Dr Mary Ghazawy and I'm one of the newest additions to the neonatologists here. It's a great service we're able to provide so in the NICU, we take care of babies born as early as 23 weeks, so that's four months early. And we are able to do screening here in house from when they're about five weeks after birth. And the Retcam involves taking pictures and the guys who can send them back to Brisbane, if they're worried and then get advice on treatment. The biggest thing that allows actually is [for] families to stay here and not have to travel back and forth to Brisbane, especially when their babies are still quite sick and quite unwell. They can stay in a unit that they know [and] built trust with. Being born early, you go from being in this really low stimulus state of being in the womb to being outside with all of this lights and all of this noise that can cause overgrowth of the blood vessels at the back of the eyes. And when that happens, it can lead to the retina coming away from the from the back of the eyes because of them that overgrowth of the blood vessels. So that's the biggest risk and that's why you can get blindness from from retinopathy of prematurity, which, incidentally, if you don't know is how Stevie Wonder went blind. He was born at 34 weeks and got retinopathy of prematurity. So the ophthalmologists, the eye screening guys, and they keep a really close eye on that. And if they're worried that it's looking like those blood vessels are growing too quickly, then they will step in and stop that.
Dr Shuan Dai
You know, when you take images normally you sit up in the front cameras, but this [is] the only facility actually, you can do image when a baby lie flat, or supine. So means you know, the premature babies, little babies, they won't be able to stand or sit still. So this gives you the ability actually to capture image of the retina. One shot will give you 130 degree field of view. If we use the old way we do eye screening I use instruments and it just takes so much time for me to see each quadrant of the retina. And so this is much easier, typically you only need a three image[s] in each eye. Sometimes we tend to over treat and because we worry things might go wrong. But with the facility you can compare image a week on week off and give you the confidence and a disease actually, in fact has not [got] worse they may even get a bit better. So when will you have this machine or the device is you actually have the confidence to a watch and wait without actually ticker intervention.
Dr Ali Haider
RPO is graded in stages and you know very rarely do we see stage four or five disease where they have you know [have] some total or partial attachments but but once it gets to a certain stages of severity, it needs to be treated, generally within 48 hours or 48-72 hours will be the timeframe from the time that a decision is made to treat that the baby should be injected here. You want to be pretty efficient in getting those images over to Brisbane and you know confirming a plan with our sub-specialist colleagues, it doesn't have to happen within the hour. It's still pretty critical that these babies get these medications and get the treatment done.
Dr Shuan Dai
Most of this treatment is done in Brisbane but because the facility [has] a telehealth program across the state, some of North Queensland babies [can] be treated actually in Townsville. This condition cannot wait, once the retina is detached there is very little you can do. The good news [is] the baby with this condition that treatment is very effective often just require one injection that is done. So they will have a guaranteed good vision in the rest of our lives. The treatment actually can be done at bedside, means the baby never required to be moved, it's us the doctor can deliver treatment and get to the baby's bedside, do the treatment. The injection is the preferred choice of treatment for many of those conditions, and the treatment itself takes literally five to 10 minutes. Imagine we transfer the baby organise everything takes some time days to, to eventuate.
Dr Ali Haider
I think communication is key with all these patients. So we have a protocol where we give them written information. All premature babies will receive notice and brochures about retinopathy of prematurity screening. So by the time we come in, they kind of have an idea [of] what we're trying to do. But for an initial screen, I will always have a chat with the parents and tell them what we're trying to screen for and the reason why we're screening for it. And as long as I know that they're more comfortable. Obviously, it's a bit of a traumatic experience for the bub and generally the parents to watch invasive examination of an eye. So we always give them the option to step out or stay in if they wish. But I think keeping them apprised of what we're doing and why we're doing it generally is the key thing.
Dr Mary Ghazawy
Here in Townsville, we've also got a good range of sub specialties in house. So down in the paediatric department, we've got an endocrinologist, someone who with a good interest in gastroenterology, someone with a good interest in neurology, so we'll often speak in house before speaking to Queensland Children's to get their advice. But whenever we do need them, they're always on the end of the phone and willing to work together to help coordinate whatever care we need to give these babies. It means that they're getting the best care regardless of where they live, really. And that's that's the goal of having a regional hub up here in the North.
Dr Shuan Dai
We actually start the journey of [setting up] the Queensland Statewide Retinal Imaging Facility to cater the service for our kids of need. And you know, so far has been very excited. So we started with training our nurses from different centres. And we have now over 50 nurses in Queensland [who] are fully trained. So we'll be able to actually to provide a service remotely for services in a region.
Belinda Vayro
It's been a fabulous opportunity to come down here today and actually work with the clinicians and Dr. Dai. They've also assisted us in showing us the techniques and the skill set to actually take the images which has been really beneficial to us. And we'll be able to take those skills back to Sunshine Coast and help other clinicians with training.
Gillian Matthews
They also developed a really comprehensive teaching package for us that we've been working through as well. So we've really, really enjoyed the day.
Fiona Mead
If I can train someone up and know that they've gone to their hospital, and they can screen their babies, it means that someone from here doesn't have to go there. And it's less for the baby, the baby doesn't have to be put in an ambulance with a nurse, brought to us for us to review. So if they can review the babies at their satellite hospitals, it's a benefit to everybody and not even even considering the cost because I'm sure it's much more cost effective.
Dr Shuan Dai
In Queensland they have telehealth for this particular ROP screening it really started in four years ago, when I can on board. I find that we have lots of inconsistencies. For example, even screening for babies with same condition, we use different guidelines. So I think we change those since we now have a statewide guideline all the NICUs across the state follow the same guidelines. So we don't have this ambiguity. Particularly parents don't need to be caught in between, you know, the health providers and I'm very proud to say I'm the first person to actually use this in New Zealand and I can recall 12 years ago when I first started to use this. I have lots of my colleagues questions say why you think it a camera can do the job. I say because they camera do a better job because you know the baby the retina image never change. But if I rely on my personal view just look the eyes. I have to tell you what I see. But if I give you an image you can see what condition a baby has. So these really make the care quality super improved because I can source opinion from anywhere in a corner of the world for a condition I don't understand just because we have this telehealth facilities, so the baby receives the best expert advice for their condition. So I think is, is, is really a game changer for the retinopathy screening.
