To report on a 6-year experience with wide-field digital imaging based telemedicine (WFDI telemedicine) to reduce the risk for blindness from retinopathy of prematurity (ROP).
Wide-angle digital fundus cameras (RetCam 120, Massie Lab, Pleasanton, CA, USA) were installed in five neonatal intensive care units (NICUs) in Germany. All prematures at risk were screened with WFDI, and the local ophthalmologists were asked to continue binocular indirect ophthalmoscopy (BIO) according to the German guidelines. Image data were coded and transferred to the Reading Centre in Regensburg. Image evaluation and additional BIO of infants with suspected treatment-requiring ROP (STR-ROP i.e. threshold ROP zone II, prethreshold ROP zone I (type-1 ROP according to ETROP), and ROP possibly requiring treatment but not reliably classifiable from the images) were performed by paediatric ophthalmologists at the Reading Centre. ROP was classified following ICROP, ETROP, and revised ICROP criteria. Outcome measures were incidence of clinically relevant ROP (CR-ROP, i.e. any ROP up to mid-peripheral zone III, ≤ stage 3+), sensitivity to detect STR-ROP, and positive predictive value to detect treatment-requiring ROP (TR-ROP).
In total, 1,222 prematures at risk were screened (mean BW 1395 g, SD ±507 g; mean GA 30 wks, SD ±3 wks). The overall incidence of CR-ROP was 27.6% (71.8% mild = stage 1 to 3 without plus disease, 15.7% prethreshold = type-1 ROP according to ETROP, 12.5% threshold according to ICROP). Zone I disease was present in 3.3%, zone II disease in 76.5%, and zone III disease in 20.2%. According to ETROP, 95 infants were type-1 or type-2 ROP; 67.4% type-1 ROP, and 32.6% type-2 ROP. Of all 1,222 infants, 3.5% received treatment. Following ETROP (not applied in the study), 5.3% would have been treated. The sensitivity for detecting STR-ROP was 100%, and the positive predictive value for TR-ROP 82.4% (28/34) at the time of the first referral (28 infants, ≤ stage 3+ in zone I or II).
All TR-ROP was detected in time, showing the potential of our telemedical screening program. The overall incidence of CR-ROP was comparable to ROP incidences reported in other West European countries.
Retinopathy of prematurity (ROP); Wide-field digital imaging (WFDI); RetCam 120; Telemedicine; Sensitivity; Positive predictive value
Aim: A cross sectional (prevalence) study was performed to assess the usefulness and sensitivity of commonly employed criteria to identify infants for routine ophthalmoscopic screening for retinopathy of prematurity (ROP).
Methods: At a tertiary care centre between 1 January 1992 and 30 June 1998, experienced vitreoretinal specialists screened 438 premature infants for ROP. Retinal maturity and the presence of ROP were determined by indirect ophthalmoscopic examinations.
Results: Of the eligible infants surviving 28 days, 276 (91.7%) of 301 infants with birth weights ≤1500 g and 162 (52.3%) of 310 infants with birth weights between 1501 and 2500 g were screened for ROP. 10 (3.9%) of the 310 infants with larger birth weights developed stage 1 or 2 ROP. Two (0.6%) of the 310 infants with larger birth weights developed stage 3 ROP. These two infants progressed to threshold ROP and required treatment.
Conclusions: Relatively restrictive criteria to identify premature infants eligible for routine ophthalmoscopic screening for ROP may be the cause for some infants going unexamined and their ROP undetected.
retinopathy; premature infants; low birth weight; blindness; visual impairment
AIM—To determine if a non-ophthalmologist can accurately screen for retinopathy of prematurity (ROP) by evaluating the posterior pole blood vessels of the retina. ROP is a common ocular disorder of premature infants and may require multiple screening examinations by an ophthalmologist to allow for timely intervention. Since there is a strong correlation between posterior pole vascular abnormalities and vision threatening ROP, screening examinations performed by non-ophthalmologist may yield useful clinical information in high risk infants.
METHODS—Infants born at the Medical University of South Carolina who met screening criteria (n = 142) were examined by a single non-ophthalmologist using a direct ophthalmoscope to evaluate the posterior pole blood vessels for abnormalities of the venules and/or arterioles. To determine the accuracy of the non-ophthalmologist's clinical observations, infants were also examined by an ophthalmologist, using an indirect ophthalmoscope, who graded the posterior pole vessels as normal, dilated venules, or dilated and tortuous venules and arterioles (including "plus disease").
RESULTS—There was significant correlation (p <0.001) between the non-ophthalmologist's and ophthalmologist's diagnoses of posterior pole vascular abnormalities. 47 infants had normal posterior pole blood vessels by the non-ophthalmologist examination. Of these, 31 (66%) were considered to have normal vessels and 16 (34%) to have dilated venules by the ophthalmologist. The non-ophthalmologist correctly identified abnormal posterior pole vessels in all 21 infants diagnosed with abnormal arterioles and venules by the ophthalmologist. No infants with clinically important ROP ("prethreshold" or worse) would have failed detection by this screening method.
CONCLUSION—Using a direct ophthalmoscope, a non-ophthalmologist can screen premature infants at risk for ROP by evaluating the posterior pole blood vessels of the retina. While not necessarily recommended for routine clinical practice, this technique may nevertheless be of value to those situations where ophthalmological consultation is unavailable or difficult to obtain.
Bell's phenomenon (BP), which may disturb screening examinations for retinopathy of prematurity (ROP), is known to present infrequently in premature babies. Stress associated with the examinations can influence expression of BP. The authors of the present study evaluated BP during examinations for ROP.
The present study included 102 eyes of 51 premature babies. Expression of BP was assessed at 3 steps of the examination in the following order: after insertion of a speculum, after illumination of an indirect ophthalmoscope and after scleral depression. The relationship between the expression of BP and the gestational age at the examination was analyzed in each step of the examination.
The frequency of BP after the speculum insertion and the illumination was 77% to 92% in infants 32 weeks of age or younger, and decreased significantly to 16% to 57% in infants 42 weeks of age or older (p < 0.005). BP after the scleral depression had no significant association with the gestational age. Frequency of BP increased significantly as the steps of the examination proceeded (p < 0.01).
BP was frequent in premature infants during ROP examination in spite of neurological immaturity. The examiner should take BP into consideration, which frequently occurs in younger infants.
Bell's phenomenon; Retinopathy of prematurity
Screening for detection of retinopathy of prematurity (ROP) currently is limited to indirect ophthalmoscopy, which requires considerable examiner skill and experience. We investigated whether conventional 10 MHz B-scan ultrasonography could document the clinical stages of ROP as accurately as indirect ophthalmoscopy.
Thirty-four eyes of 18 neonates were examined by masked, independent observers with indirect ophthalmoscopy and digitally recorded 10-MHz B-scan ultrasonography. After pupil dilation and lid speculum placement, the retinologist recorded the stage of retinopathy with a retinal drawing. The ultrasonographer, without use of papillary mydriatics or lid speculum, determined the presence or absence of a ridge or tractional elements, if present on the ridge.
Ultrasound grade correlated with clinical grade (R = .79, P < .001). However, nine eyes were overdiagnosed by one stage, and one eye, in which a peripheral detachment was mistaken for an artifact, was underdiagnosed.
Ten-megahertz ultrasonography offers the potential of imaging and detecting the clinical stages of ROP; the use of higher ultrasound frequencies, now becoming commercially available, is likely to enhance diagnostic accuracy. Care must be taken to distinguish between artifact and true anatomical structures in noncontact ultrasound examinations. Neonates with suspected ROP could be screened with B-scan ultrasonography by neonatal personnel without pupillary dilatation or lid speculum, thus eliminating potential morbidity, and clinically significant cases of ROP then could be referred to the retinologist.
To compare 20-MHz ultrasonography with ophthalmoscopy in the staging of retinopathy of prematurity (ROP).
We used a handheld 20-MHz ultrasound system to examine 38 eyes of 19 neonates who had an indirect ophthalmoscopic examination (diagnosis masked) within 48 hours prior to ultrasonography. Determination of ROP by indirect ophthalmoscopy was compared with independent identification of ultrasonic features indicative of ROP stages.
In masked cases, ultrasonography correctly identified 13 of 18 (72.2% sensitivity) eyes with zone 2, stage 2 ROP or worse and 19 of 20 (95.0% specificity) normal eyes (zone 2, stage 1 ROP or better) (chi-square, 18.4; P < .001).
In the neonatal nursery, a 20-MHz handheld ultrasound system may be an effective screening tool to initially identify ROP for further ophthalmoscopic evaluation and management.
AIMS--The anatomical and functional outcome of 13 babies with retinopathy of prematurity (ROP) treated with binocular indirect ophthalmoscope diode laser photocoagulation was assessed. METHODS--Thirteen babies (25 eyes) at median postmenstrual age (PMA) 25.5 weeks and median birth weight 725 g were treated with binocular indirect ophthalmoscope (BIO) diode laser photocoagulation when threshold retinopathy of prematurity (ROP) was detected at median PMA 35 weeks. Retinopathy was more severe in the nasal retina in 15 eyes. The median severity of retinopathy was 6 clock hours grade 3 disease. All babies were treated under general anaesthetic with no significant ocular or systemic complications during treatment. The median number of burns was 1200. RESULTS--Resolution of active retinopathy occurred 1-2 weeks following treatment in all but one baby. All eyes had favourable anatomical and functional outcome as defined by the Cryo-ROP study group at a median age of 19.5 months of follow up. CONCLUSION--BIO diode laser treatment is as effective as cryotherapy with less morbidity.
AIM—To assess whether treatment of premature infants with dopamine is a risk factor for development of retinopathy of prematurity (ROP).
METHODS—A retrospective case series analysis of two groups was utilised with a minimum follow up of 6 months. Clinical profiles and patient risk factors were identified along with an evaluation of ROP progression and an analysis of clinical outcome. All infants were seen in a single community neonatal intensive care unit (NICU). 41 consecutive high risk infants were identified during a 36 month period whose birth weight was less than 1000 grams and who remained in the NICU without transfer until at least 28 days of age. Dilated indirect ophthalmoscopy fundus examinations were performed on all infants to identify the degree of and progression to threshold ROP.
RESULTS—18 of 41 infants were treated with dopamine for hypotension. The group of infants requiring dopamine differed statistically from the non-dopamine treated group by having a slightly higher birth weight, a greater incidence of hypotension and colloid treatment, and in manifesting more advanced respiratory disease. Within the dopamine treated group, 12 of 18 infants (67%) reached prethreshold ROP and seven infants (39%) reached threshold ROP requiring laser treatment. In contrast, only three of the infants (13%) who did not require dopamine for hypotension progressed to prethreshold (p=0.001) and only one of these infants (4%) progressed to threshold ROP (p = 0.02). Logistic regression analysis among other variables demonstrated that dopamine use and gestational age are important factors in this low birthweight population for predicting the development of threshold ROP (dopamine use: adjusted odds ratio = 119.88, p = 0.0061; gestational age: adjusted odds ratio = 0.061, p = 0.0043).
CONCLUSIONS—Dopamine use in low birthweight infants may therefore be a risk factor for the development of threshold ROP. More vigilant screening of high risk infants requiring dopamine therapy for systemic hypotension may be warranted.
Keywords: dopamine; retinopathy of prematurity; infants
To compare vitreoretinal pathology imaged with portable handheld spectral domain optical coherence tomography (SDOCT) to conventional indirect ophthalmoscopic (IO) examination in neonates undergoing screening for retinopathy of prematurity (ROP).
SDOCT images were collected from 76 eyes of 38 neonates during 118 routine ROP examinations. Imaging sessions in the neonatal intensive care unit were performed immediately after the subjects underwent a standard ophthalmic examination with IO by a pediatric ophthalmologist. Masked certified SDOCT graders evaluated scans for preretinal and retinal findings including material in the vitreous, epiretinal membrane, intraretinal cystoid structures and deposits, optic nerve and vascular features, as well as severity and location of ROP. The frequency of detection of these features by clinical examination and evaluation of SDOCT images was compared to determine potential clinical advantages for each modality.
Portable SDOCT imaging characterized macular features of retinal cystoid structures in 39% of exams and epiretinal membrane in 32% of exams. Neither feature was visualized by indirect ophthalmoscopy in any cases. The clinician using indirect ophthalmoscopy detected stage of ROP and the presence or absence of plus or pre-plus disease. These were not visualized with SDOCT.
SDOCT provides new information about the premature infant retina that is of unknown importance relative to visual development and acuity. As used in this study, SDOCT does not replace indirect ophthalmoscopy for evaluation of ROP.
Macular edema; Premature neonates; ROP; SDOCT; Visual development
To analyze the incidence and risk factors for retinopathy of prematurity (ROP).
A retrospective analysis was conducted on 568 premature infants from September 2005 to December 2010 with birth weight(BW) equal to or less than 2 500g or a gestational age(GA) at birth of 34 weeks or less. All of the members were examined by indirect binocular ophthalmoscopy.
ROP occurred with an incidence rate of 10.7% among 568 premature infants, and stages 3 and above ROP occurred with an incidence rate of 2.5%. This study showed the infants were more prone to develop ROP with short geststional age, low BW, long time of oxygen inhalation, and severe infants diseases. Twins had a significantly higher rate of ROP(18.3%) than singleton babies(9.8%), ROP were severer in twins than singleton babies.
Short GA, low BW, long time of oxygen inhalation, severe infants diseases, and non-singleton babies were the most significant risk factors associated with ROP.
retinopathy of prematurity; ROP epidemiology; ROP incidence
Retinopathy of prematurity (ROP) is a serious complication in preterm infants. To avoid this complication the risk factors leading to the disabling disease should be evaluated and prevented.
This is a descriptive study. All preterm infants with birth weight under 1500 g and preterm infants with birth weight between 1500–2000 g who had unstable clinical condition and admitted in neonatal intensive care unit from February 2006-March 2007 at tertiary hospitals of Shiraz University, Iran, were introduced into the study. All infants are examined by indirect ophthalmoscopy. Risk factors analysis was performed in two groups. Group 1 consisted of infants with no ROP or ROP that regressed spontaneously, and Group 2 of those with severe ROP that needed laser therapy.
Of 199 preterms, ROP that needed laser therapy was detected in 19 (9.5%); 65 (32.6%) had ROP that regressed spontaneously and 115(57.8%) had no ROP. Risk factor analysis showed significant P-values for gestational age, birth weight, Apgar score of first minute, mean duration of mechanical ventilation, mean duration of oxygen therapy, eclampsia-preeclampsia, hypoxia, hyperoxia, Pa CO2 >60 mmHg, pH>7.45 and frequent blood transfusions. Using stepwise logistic forward regression showed the three factors mean duration of oxygen therapy, birth weight and mechanical ventilation to be independently significant variables for increasing the rate of ROP.
The main risk factors for development of threshold ROP are low birth weight, mechanical ventilation and duration of oxygen therapy. So it seems that prevention of premature delivery and judicious oxygen therapy is the main step for prophylaxis of ROP.
Retinopathy of prematurity; Incidence; Risk factors; Treatment; Hyperoxia
The aim of this study was to report the incidence of retinopathy of prematurity (ROP) and the contribution of various risk factors to ROP in the south-western region of Iran.
Material and Methods:
This cross-sectional case-control series reviewed all low birth weight (LBW, ≤2000 g) neonates and/or neonates less than 32 weeks gestational age who had been hospitalized in the Neonatal Intensive Care Unit from 2006 to 2010. The cohort was divided into infants without ROP (nonROP group) and infants with ROP (ROP group). Infants were first examined by a group of pediatric ophthalmologists 6 weeks after delivery, and then were followed every 1-2 weeks until death, discharge or complete retinal avascularization. If an infant developed ROP, further examinations were performed based on the Early Treatment for Retinopathy of Prematurity Study protocol. Demographic data, medical treatment, and ophthalmic disorders were all statistically analyzed.
A total of 576 infants met the criteria for evaluation. Of 576 total patients, 183 infants (32%) (88 males, 95 females) had ROP. There were significant differences between groups in gestational age, body weight, and duration of oxygen administration, and sepsis (P<0.05). Male/female ratio, single and multiple births, and jaundice, phototherapy, and blood transfusion were not significant. The majority of ROP was stage I or II (137, 74.8%). Stage III or greater developed in 46 infants (25.1%) [Note: The ocular history and ocular outcomes are not risk factors.]
The incidence of ROP in this study is higher than that in other parts of the world. Awareness and knowledge of ROP and its relative risks need to be reinforced in ophthalmologists and other health practitioners.
Incidence; Prematurity; Retinopathy; Risk Factors
AIM—To determine the visual outcome at 7-8 years in very low birth weight (VLBW: birth weight <1500 g) infants screened for retinopathy of prematurity (ROP).
METHODS—In 1986 all 413 VLBW infants admitted to neonatal units in New Zealand were enrolled in a prospective study of acute ROP. Surviving infants were traced and assessed at a home visit. Visual assessment comprised examination for abnormal and range of eye movements, visual fields, distance and near visual acuity, stereopsis, and photorefraction.
RESULTS—Of 338 infants surviving to discharge, 313 (93%) had been examined for acute ROP. ROP was present in 66 (21%: ROP+), absent in 247 (ROP−), with 25 not examined (NA). 298 children (96% survivors resident in New Zealand: 91% all survivors) were assessed. Any visual problem occurred in 79% ROP+ and 60% ROP−/NA (p<0.01). Distance visual acuity less than 4/10 in the worse eye occurred in 29% ROP+ and 15% ROP−/NA (p<0.05); and in the better eye in 19% ROP+ and 5% ROP−/NA (p<0.001). Any myopia in the worse eye occurred in 36% ROP+ and 18% ROP−/NA (p<0.01); and in the better eye in 25% ROP+ and 11% ROP−/NA (p<0.01). Strabismus, including treated, occurred in 33% ROP+ and 19% ROP−/NA (p<0.05). Overall, 11% had astigmatism and 18% hypermetropia with no difference between the groups.
CONCLUSION—In a population based study it was confirmed that VLBW is associated with an increased risk of visual problems at school age. A history of ROP is associated with an additional risk of poor outcome, including a near doubling of poor distance acuity, myopia, and strabismus.
OBJECTIVE: The purpose of this study was to determine the effectiveness of laser photocoagulation in eyes with threshold retinopathy of prematurity (ROP), defined as stage 3+, zone 2, with 5 or more contiguous or 8 cumulative clock hours of extraretinal fibrovascular proliferation. METHODS: Indirect ophthalmoscopic retinal examinations were performed on 18 premature infants born between 1991 and 1993 to identify those eyes with threshold ROP. Diode laser was used to treat 31 eyes within 48 hours of diagnosis. Each patient was followed post treatment at weekly intervals until regression was starting to occur. Subsequent follow-up visits were tailored to each patient. RESULTS: During the 41 to 60 month follow-up (average 49 months, median 46 months), 27 of 31 lasered eyes (87%) demonstrated regression of the extraretinal neovascularization, and 26 (84%) had functional vision. This includes two Stage 4B eyes that were reattached with scleral buckles. Twenty-two eyes (71%) were myopic and four (13%) progressed to stage 5 retinal detachment that could not be repaired. No cataracts occurred in this group of patients. CONCLUSIONS: Although a potentially blinding disorder, threshold ROP is, in many cases, treatable with laser photocoagulation, which may be easier to administer than cryotherapy. Follow-up of patients treated with diode laser demonstrates that functional vision is attainable.
To elucidate the subclinical anatomy of retinopathy of prematurity (ROP) using spectral domain optical coherence tomography (SD OCT).
Prospective, observational case series.
Three low-birth-weight, severely premature infants.
Clinical examination was performed using a portable slit lamp and indirect ophthalmoscope. Imaging was performed by using a handheld SD OCT device and Retcam (Clarity Medical Systems, Pleasanton, CA) or video-indirect recording. Spectral domain optical coherence tomography imaging was conducted without sedation at the bedside in the neonatal intensive care unit on 1 patient. The other 2 patients had an examination under anesthesia with SD OCT imaging in the operating room.
Main Outcome Measures
In vivo determination of vitreoretinal morphology, anatomy, and pathology by clinical examination, imaging, and SD OCT.
Linear and volumetric imaging was achieved with the handheld system in infant eyes despite tunica vasculosa lentis and vitreous bands. Imaging was not possible in eyes with notable vitreous hemorrhage. Analysis of SD OCT images revealed preretinal structures (ranging from 409 to 2700 μm in width and 212 to 440 μm in height), retinoschisis, and retinal detachment in the posterior pole of patients with advanced ROP. Both the retinoschisis and the preretinal structures were not identified on conventional examination or imaging by expert pediatric ophthalmologists. The preretinal structures varied in location and size, and may represent preretinal fibrovascular proliferation. Some were found in close proximity to blood vessels, whereas others were near the optic nerve.
Handheld SD OCT imaging can be performed on the sedated or nonsedated neonate and provides valuable subclinical anatomic information. This novel imaging modality can reveal the location and extent of posterior ROP pathology not evident on standard examination. This could affect future clinical decision-making if studies validate a management strategy based on findings from this imaging technique.
Preterm infants weighing <1500 grams routinely undergo a series of eye examinations to screen for retinopathy of prematurity (ROP). While these examinations are important for the prevention of blindness, infants may suffer adverse physiologic events during and after the examination. The procedure includes administration of mydriatic eye drops that may be absorbed systemically and physical manipulation of the eye that is accompanied by stress and pain. The purpose of the study was to monitor changes in infant health status and adverse physiologic events in the two days following ROP eye screening.
The study used 50 preterm infants with a mean gestational age of 32 weeks, undergoing their first ROP examination in a NICU located in a university medical center.
This pilot study used a prospective, descriptive design.
Physiologic changes and illness events were recorded before and for two days after the eye examination, using tools that tracked parameters of respiratory, cardiovascular, gastrointestinal, and neurological status. Data were collected directly from daily audits of medical records. McNemar’s test for comparing paired proportions and the signed rank test were used for comparing significance of physiologic changes before and after the ROP eye examination.
Apnea events increased significantly (p=0.04) in the 24–48 hour period after the eye examination compared to apnea events before the eye examination. These results were based on 39 infants who were not receiving ventilator support. There was a significant difference in the frequency of oxygen desaturation events between infants with and without apnea (0–24 hours after examination p<0.002, 25–48 hours after examination, p<0.001). There were no significant differences in heart rate, cyanosis, gastric residuals, or seizures after the eye examinations.
ROP examinations may be associated with increased apnea, a clinically significant problem. Nursing implications include careful monitoring of infants during and after ROP eye examinations, discharge teaching for caregivers, and continued research on nursing interventions to prevent adverse physiologic events.
preterm infant; retinopathy of prematurity; screening examinations; apnea
Retinopathy of prematurity (ROP) is a disorder of the developing retinal blood vessels of the preterm infant. New recommendations for screening and treatment of ROP have been published in the past few years. Current evidence suggests that screening infants with gestational ages of 30 6/7 weeks or less (regardless of birth weight) and birth weights of 1250 g or less is a strategy with a very small likelihood that an unscreened baby would have treatable ROP. Individual centres may choose to extend birth weight screening criteria to 1500 g. Initial screening should be performed at 31 weeks’ postmenstrual age in infants with gestational ages of 26 6/7 weeks or less at birth, and at four weeks’ chronological age in infants with gestational ages of 27 weeks or more at birth by an ophthalmologist skilled in the detection of ROP. Follow-up examinations are conducted according to the ophthalmologist’s recommendation. Infants with high-risk prethreshold ROP and threshold ROP are referred for retinal ablative therapy. Developing processes for ROP screening, documenting results and communicating results to parents as well as health professionals involved in the infant’s care are important responsibilities for all nurseries providing care for preterm infants.
Laser therapy; Preterm infant; Retinopathy of prematurity; Screening
Telemedicine offers potential to improve the accessibility and quality of diagnosis of retinopathy of prematurity (ROP). The aim of this study was to measure accuracy of remote image based ROP diagnosis by three readers using receiver operating characteristic (ROC) analysis.
64 hospitalised infants who met ROP examination criteria underwent two consecutive bedside procedures: dilated examination by an experienced paediatric ophthalmologist and digital retinal imaging with a commercially available wide angle camera. 410 images from 163 eyes were reviewed independently by three trained ophthalmologist readers, who classified each eye into one of four categories: no ROP, mild ROP, type 2 prethreshold ROP, or ROP requiring treatment. Sensitivity and specificity for detection of mild or worse ROP, type 2 prethreshold or worse ROP, and ROP requiring treatment were determined, compared to a reference standard of dilated ophthalmoscopy. ROC curves were generated by calculating values for each reader at three diagnostic cut‐off levels: mild or worse ROP (that is, reader was asked whether image sets represented mild or worse ROP), type 2 prethreshold or worse ROP (that is, reader was asked whether image sets represented type 2 prethreshold or worse ROP), and ROP requiring treatment.
Areas under ROC curves ranged from 0.747–0.896 for detection of mild or worse ROP, 0.905–0.946 for detection of type 2 prethreshold or worse ROP, and 0.941–0.968 for detection of ROP requiring treatment.
Remote interpretation is highly accurate among multiple readers for the detection of ROP requiring treatment, but less so for detection of mild or worse ROP.
retinopathy of prematurity; retinal diseases; telemedicine; medical informatics; neonatology
AIMS/BACKGROUND—In a prospective study the degree of distress caused by retinopathy of prematurity (ROP) screening in a cohort of preterm infants was assessed and the modifying effects of nesting in reducing their discomfort was evaluated.
METHODS—38 preterm infants were included in the study. 19 infants were placed in a nest with boundaries (intervention group) and 19 infants were placed on a cot blanket (control group). Observations were made 2 minutes before, throughout, and 2 minutes after ROP examination. The factors observed were crying responses, neurobehavioural activity, and physiological changes (heart rate, oxygen saturation). Recordings were made using a video camera for crying and neurobehavioural activity and an Oxypleth monitor for heart rate and oxygen saturation.
RESULTS—During ROP screening, the total group of 38 infants (nested and non-nested combined) displayed increased neurobehavioural activity (p<0.01) and crying (p<0.01). The increased activity and crying coincided with the invasive part of the procedure. The distress caused by ROP screening was significantly less for the nested group compared with the non-nested group for both movement activity (p<0.01) and crying (p<0.01). The physiological data, heart rate, and oxygen saturation were not statistically significant.
CONCLUSION—ROP screening is distressing for preterm infants. Nesting can significantly reduce this discomfort. The findings in this study are of value in designing more optimal ROP examination schedules for infants.
This study was conducted to determine the distribution and risk factors of retinopathy of prematurity (ROP) in premature infants referred to neonates intensive care unit (NICU) of central hospital of Kerman University of Medical Sciences, to obtain primary information on ROP in Kerman, Iran.
In a cross sectional prospective study, data of premature infants screened for ROP including possible risk factors and eye examination results were recorded during 2006-2008 and analyzed by using logistic regression and chi-square tests.
Out of 83 premature infants, 24 (29%) had different stages of ROP (CI 95%: 0.19-0.39). The infants’ mean gestational age (GA) and mean birth weight (BW) in ROP group were 30.17±1.8 weeks and 1247.92±237.1 grams (g), respectively. Logistic regression analysis showed a significant relation between GA and BW with ROP (P<0.001). Indication for treatment was set in 6 (25%) infants.
The results of this study illustrate a relatively high prevalence of ROP in this series. GA and BW were independent ROP determinants.
Prematurity; Prevalence; Retinopathy; Birth Weight; Gestational Age; Neonate
To take fundus examination in the preterm neonates to observe the common diseases and report the outcomes in a neonatal intensive care unit (NICU) in Guangzhou between May 2008 and May 2011.
Fundus examinations were performed with Retcam II in 957 prematures.
There were 957 prematures in this study, including 666 males and 291 females, 2 triple births, 152 twins and 803 singletons. During the three years, 86 infants with any stage retinopathy of prematurity (ROP) (9.0%), 123 infants with retinal hemorrhage(12.9%), 10 infants with neonatal fundual jaundice(1.0%) and 3 babies with congenital choroidal coloboma (0.3%) were found.
Early detection and prompt treatment of ocular disorders in neonates is important to avoid lifelong visual impairment. Examination of the eyes should be performed in the newborn period and at all well-child visits.
fundus examination; premature; retinopathy of prematurity; retinal hemorrhage; choroidal coloboma; early detection
PURPOSE: Labor-intensive screening of infants in the neonatal intensive care units is the only way to detect retinopathy of prematurity (ROP). Our purpose is to determine if RetCam 120 photos, acquired by a neonatal nurse, can be used to screen for ROP by performing 2 screening examinations, at 32 to 34 weeks (exam 1) and at 38 to 40 weeks (exam 2) post-conceptional age. METHODS: RetCam examinations are performed by a nurse on infants at exam 1 and exam 2 intervals. At the same time, an examination is performed by an experienced ophthalmologist. Masked readers evaluate the photos for ROP and determine if each eye will progress to prethreshold or threshold disease. The data are compared to the clinical course of the eyes. RESULTS: Forty-six eyes were photographed at exam 1 and 50 eyes at exam 2 from July 1, 1999, to December 15, 1999. Sensitivity and specificity of detecting ROP were 76% and 100% for exam 2 and 46% and 100% for exam 1. Sensitivity and specificity of predicting prethreshold disease were 64% and 97% for exam 2 and 33% and 100% for exam 1. Sensitivity and specificity of predicting threshold were both 100% at exam 2 and 0% (one photo in category) and 95% at exam 1. CONCLUSION: A potential reason for low sensitivity is technical limitations of the Retcam, such as the difficulty in capturing peripheral retina in small eyes and the need for a better lid speculum.
To present the final results of the Early Treatment for Retinopathy of Prematurity Study.
Infants with bilateral high-risk prethreshold retinopathy of prematurity (ROP) (n = 317) had one eye randomized to early retinal ablative treatment and the fellow eye managed conventionally (control eye). In asymmetric cases (n = 84), the eye with high-risk prethreshold ROP was randomized to early or to conventional management. High risk was determined using a model based on the Cryotherapy for Retinopathy of Prematurity natural history cohort. The primary outcome was visual acuity assessed by masked testers using the Teller acuity card procedure. Structural examinations were performed at 6 and 9 months.
Grating acuity results showed a reduction in unfavorable visual acuity outcomes with earlier treatment, from 19.8% to 14.3% (P < .005). Unfavorable structural outcomes were reduced from 15.6% to 9.0% (P < .001) at 9 months. Further analysis supported retinal ablative therapy for eyes with type I ROP, defined as zone I, any stage ROP with plus disease; zone I, stage 3 ROP without plus disease; or zone II, stage 2 or 3 with plus disease. The analysis supported a “wait and watch” approach to type II ROP, defined as zone I, stage 1 and 2 without plus disease, or zone II, stage 3 without plus disease. These eyes should be considered for treatment only if they progress to type I ROP or threshold.
Early treatment of high-risk prethreshold ROP significantly reduced unfavorable outcomes in both primary and secondary (structural) measures.
Aims: To measure characteristics of the retinal blood vessels close to the optic disc in full term and preterm infants, with and without retinopathy of prematurity (ROP), using digital imaging. To determine whether these measures are indicative of the presence or severity of ROP in the retinal periphery.
Methods: 52 digital fundus images from 42 babies were analysed with a semiautomated analysis program developed at Imperial College London. Analysis was limited to the principal temporal vessels close to the optic disc: recording venular diameter and arteriolar diameter and tortuosity.
Results: Each result was categorised by the gestational age of the infant (“very premature” 24–27 weeks, “moderately premature” 28–31 weeks, and “near term” ⩾32 weeks) and by the highest stage of ROP present (“no ROP,” “mild ROP” stage 1 or 2, and “severe ROP” stage 3). Arteriolar tortuosity was found to vary significantly (Kruskal-Wallis p = 0.002) with ROP severity. Although venular and arteriolar diameters increased monotonically with ROP severity the differences were not significant. Venular diameter, arteriolar diameter, and arterial tortuosity did not vary significantly between gestational age groups.
Conclusions: This study confirms it is possible to quantify the size and tortuosity of retinal blood vessels in term and preterm babies using digital image analysis software. This method detected significant increases in arteriolar tortuosity with increasing ROP severity.
computer analysis; vessel growth; infants; retinopathy of prematurity
To develop an efficient clinical prediction model that includes postnatal weight gain to identify infants at risk of developing severe retinopathy of prematurity (ROP). Under current birth weight (BW) and gestational age (GA) screening criteria, <5% of infants examined in countries with advanced neonatal care require treatment.
PATIENTS AND METHODS:
This study was a secondary analysis of prospective data from the Premature Infants in Need of Transfusion Study, which enrolled 451 infants with a BW < 1000 g at 10 centers. There were 367 infants who remained after excluding deaths (82) and missing weights (2). Multivariate logistic regression was used to predict severe ROP (stage 3 or treatment).
Median BW was 800 g (445–995). There were 67 (18.3%) infants who had severe ROP. The model included GA, BW, and daily weight gain rate. Run weekly, an alarm that indicated need for eye examinations occurred when the predicted probability of severe ROP was >0.085. This identified 66 of 67 severe ROP infants (sensitivity of 99% [95% confidence interval: 94%–100%]), and all 33 infants requiring treatment. Median alarm-to-outcome time was 10.8 weeks (range: 1.9–17.6). There were 110 (30%) infants who had no alarm. Nomograms were developed to determine risk of severe ROP by BW, GA, and postnatal weight gain.
In a high-risk cohort, a BW-GA-weight-gain model could have reduced the need for examinations by 30%, while still identifying all infants requiring laser surgery. Additional studies are required to determine whether including larger-BW, lower-risk infants would reduce examinations further and to validate the prediction model and nomograms before clinical use.
infant; logistic model; premature; nomogram; retinopathy of prematurity