OSLI Retina

January 2021

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January 2021 ยท Vol. 52, No. 1 11 Editorial Malini Veerappan Pasricha Cassie A. Ludwig Darius M. Moshfeghi [Ophthalmic Surg Lasers Imaging Retina. 2021;52:11-12.] Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Truly Mobile Teleophthalmology Malini Veerappan Pasricha, MD; Cassie A. Ludwig, MD, MS; Darius M. Moshfeghi, MD The Stanford University Network for Diagnosis of Retinopathy of Prema- turity (SUNDROP) is a telemedicine-based program for in-hospital screening of infants at high risk for treatment-warranted retinopathy of prematurity (ROP) at 11 neonatal intensive care units (NICUs) in Northern California, Ne- vada, and Indiana. All screenings are performed by trained NICU nurses us- ing the RetCam family of cameras (Clarity Medical Systems, Pleasanton, CA) and transmitted remotely to a pediatric vitreoretinal surgeon reader (DMM) via synchronization in a HIPAA-compliant fashion with the SUNDROP servers. Images must be interpreted and management determined within 24 hours of examination. 1,2 The remote expert reader was preparing to board his international flight when he received images for 21 NICU patients. This presented a potential problem for the expert reader to transmit results back to the NICU within the 24-hour time allowance. The minimum time delay was 16 hours: flight duration of 10 hour 45 minutes, plus 2 hours for immigration and customs, 2 hours for travel from airport to hotel, and 1 hour for hotel check-in to remote computer login. One solution would be to tap into a backup reader, but like many other institutions with few pediatric retina specialists, this was not an option. However, upon reaching a cruising altitude of 30,000 feet, the reader con- nected to the Wi-Fi on his laptop, remotely logged into the secure server with the Stanford virtual private network (VPN) and began grading images using the proprietary viewer under a laptop privacy screen. VPN extends a private network (the health care system network in the current scenario) across a public internet connection, allowing the user to send and receive data as if they were connected to the private network. This gives the user the security From Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, California. Originally submitted June 28, 2020. Revision received November 5, 2020. Accepted for publication November 18, 2020. Drs. Pasricha and Ludwig report no relevant financial disclosures. Dr. Moshfeghi reports the following disclo- sures: 1800 Contacts (Board of Directors, Equity), Akebia (Scientific Advisory Board), Alcon (Data Safety Monitor- ing Committee), Aldeyra Therapeutics (Principal Investigator), Allegro (Scientific Advisory Board), Apellis (Site Principal Investigator), Bayer Pharma AG (ROP Image Committee, Consultant), CMEOutfitters.com (Consultant), Congruence Medical Solutions (Consultant), dSentz (Founder, Board of Directors, Equity), Genentech (Grant), Grand Legend Technology (Equity), Iconic Therapeutics (Steering Committee), Irenix (Scientific Advisory Board), Linc (Founder, Equity, Board of Directors), Northwell Health (Consultant), Novartis Pharmaceuticals (Data Safety Monitoring Committee, Consultant), Pr3vent (Founder, Board of Directors, Equity), Prime Medical Educa- tion (CME Consulting), Promisight Inc (Founder, Board of Directors, Equity), Pykus (Scientific Advisory Board, Equity), Regeneron (CME Consultant, Principal Investigator), Retina Technologies LLC (Scientific Advisory Board, Consultant), Retina Today/Pentavision (Consultant), Shapiro Law Group (ROP Expert Witness), SLACK Inc (CME Consultant), University of Miami (CME Consultant), Versl Inc (Founder, Equity), Vindico (CME consultant), and Visunex Medical Systems (Scientific Advisory Board, Equity). Dr. Moshfeghi did not participate in the editorial review of this manuscript. Address correspondence to Darius M. Moshfeghi, MD, Byers Eye Institute, Department of Ophthalmology, Stan- ford University School of Medicine, 2452 Watson Court, Palo Alto, CA, 94303; email: dariusm@stanford.edu. doi: 10.3928/23258160-20201223-03

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