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Screening for Retinopathy of Prematurity (ROP) is moving forward in the realm of technology.  Nurses have the opportunity to be part of this new and upcoming "solution" to what once used to be reserved for an ophthalmologist with experience in examination of preterm infants for ROP using binocular indirect ophthalmoscopy (BIO).  Digital Eye Exam imaging is now available to neonatal units as an adjunct to the BIO.  The "seeing" of the digital eye exam is the "believing" part to this new technology.  Nurses, neonatologists, and families have not been able to know what a neonatal patients retinal development looks like other than the "pencil sketches" left on the paper by the examiner.  With the increase in litigation surrounding the incidence of ROP, digital eye imaging is a valuable component to the "safety net" steps in preventing and avoiding poor patient outcomes. 

As a neonatal unit that has recently transitioned from a Level IIA Nursery to a Level IIIA NICU, we knew access to an ophthalmologist with ROP training would be necessary.  We have access to vitreoretinal specialists.  However, it did not seem practical to have them come to our facility to screen one or two patients at a time.  We explored the option of digital eye exams as an adjunct to the BIO with the intent to reduce the number of visits the physician would have to make to our facility.  It was also discussed that our documentation and tracking of the eye exam screenings would be enhanced with the use of digital eye imaging.    

Nurses have the ability to lead this innovative initiative in a neonatal unit yielding advanced skill training opportunities for them.  The ophthalmologist does not need to be present for the digital eye exam and can receive the images rapidly after they are transferred utilizing a telemedicine system accessed by the nurse.  Dictations are available for the patient chart after the physician review. 

Our Digital Eye Exam Imaging and Telemedicine Program for ROP began in May 2009.  It has been well received by the nursing staff and families. This paper will provide an overview of the benefits of digital eye exams and telemedicine for the premature neonate, program design including staff training, policy/procedure, tracking process, communication algorithm, and patient outcomes at time of discharge to home.  It will also discuss the challenges we faced when implementing this program.