Comparison of wide field imaging by nurses with indirect ophthalmoscopy by ophthalmologists for retinopathy of prematurity: a diagnostic accuracy study

Abstract

ObjectivesRetinopathy of prematurity (ROP) is a vasoproliferative disease of the preterm retina with the potential to cause irreversible blindness. Timely screening and treatment of ROP are critical. Neonatal nurses trained in wide field digital retinal photography (WFDRP) for screening may provide a safe and effective strategy to reduce the burden of ophthalmologists in performing binocular indirect ophthalmoscopy (BIO). The objective of the study was to determine the diagnostic accuracy of WFDRP in the diagnosis of referral warranting ROP (RWROP).DesignProspective diagnostic accuracy study.SettingA tertiary neonatal intensive care unit in Perth, Western Australia.ParticipantsPreterm infants who fulfilled the Australian ROP screening criteria (gestational age (GA) <31 weeks, birth weight (BW) <1250 g).InterventionSets of 5–6 images per eye (index test) were obtained within 24–48 hours prior to or after the BIO (reference standard), and uploaded onto a secured server. A wide field digital camera (RetCam, Natus, Pleasanton, California, USA) was used for imaging. A paediatric ophthalmologist performed the BIO. The ophthalmologists performing BIO versus reporting the images were masked to each other’s findings.Primary outcomeThe area under the receiver operating characteristic (ROC) curve was used as a measure of accuracy of WFDRP to diagnose RWROP.ResultsA total of 85 infants (mean BW; 973.43 g, mean GA; 29 weeks) underwent a median of two sessions of WFDRP. There were 188 episodes of screening with an average of five images per eye. WFDRP identified RWROP in 7.4% (14/188 sessions) of examinations. In one infant, BIO showed bilateral plus disease and WFDRP did not pick up the plus disease. WFDRP image interpretation had a sensitivity of 80%, specificity of 94.5% for the detection of RWROP. The ‘area under the ROC curve’ was 88% when adjusted for covariates.ConclusionsWFDRP by neonatal nurses was feasible and effective for diagnosing RWROP in our set up.Trial registration numberACTRN12616001386426.

Screening for Retinopathy of Prematurity Through Utilization a Pediatric Retinal Camera at Jim Pattison Children’s Hospital: A Vision for Improved Care

“…An alternate approach to ROP screening involves the use of wide-field digital retinal imaging (WFDRI). This mode of non-contact imaging can be performed by trained personnel other than an ophthalmologist, 3 which would drastically contribute to efficiency of image capture and increase the volume of screened infants at a time. A prospective cohort study by Prakalpakorn et al 15 showed that non-contact cameras are well tolerated and less stressful to the infant.…”

The Role of Widefield and Ultra Widefield Optical Coherence Tomography in the Diagnosis and Management of Vitreoretinal Diseases

“…Indeed, it overcomes several limitations of other imaging methods, such as sedation and intravenous dye injection [ 25 ]. Moreover, as previously demonstrated by Athikarisamy et al, performing quality wide-field imaging may also help in an off-site telehealth diagnosis of all patients with referral-warranting pediatric retinal diseases [ 26 ].…”

Portable wide-field digital imaging for screening of neonatal visual impairment causes in Rio de Janeiro, Brazil: a budget impact analysis

“… 7 16 It also has good accuracy (sensitivity over 70%) in identifying clinically significant (type 2 or worse) ROP when compared with indirect ophthalmoscopy. 17 18 …”

“…Portable WFDI as an ROP screening method was proven, despite the high initial cost of the equipment, to be a cost-effective strategy 7 16. It also has good accuracy (sensitivity over 70%) in identifying clinically significant (type 2 or worse) ROP when compared with indirect ophthalmoscopy 17 18…”