Non-ophthalmologist screening for retinopathy of prematurity

• Published in: British journal of ophthalmology Vol. 84; no. 2; pp. 130 - 134
• Main Authors: Saunders, Richard A, Donahue, Margaret L, Berland, Jerry E, Roberts, Eric L, Von Powers, Billy, Rust, Philip F
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.02.2000; BMJ; BMJ Publishing Group LTD
• Subjects: Age; Babies; Biological and medical sciences; Humans; Infant, Newborn; Infant, Premature; Medical personnel; Medical sciences; Neonatal Screening - methods; Neonatology - education; Ophthalmology; Ophthalmoscopy - methods; Original articles - Clinical science; Premature birth; prematurity; Retinopathies; retinopathy of prematurity; Retinopathy of Prematurity - diagnosis; screening protocols; Studies; Human; Premature; Retinopathy; Physician; Exploration; Retina; Ophthalmoscope; Medical screening; Newborn diseases; Eye disease; Newborn; Posterior pole; Blood vessel
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.84.2.130

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.