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Wide-field digital retinal imaging versus binocular indirect ophthalmoscopy for retinopathy of prematurity screening: a two-observer prospective, randomised comparison
  1. C Dhaliwal1,
  2. E Wright2,
  3. C Graham3,
  4. N McIntosh1,
  5. B W Fleck4
  1. 1
    University of Edinburgh Department of Neonatology, Simpson’s Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK
  2. 2
    Simpson’s Centre for Reproductive Health, Royal Infirmary, Edinburgh, UK
  3. 3
    Wellcome Clinical Research Facility, Western General Hospital, Edinburgh, UK
  4. 4
    Princess Alexandra Eye Pavilion, Edinburgh, UK
  1. Dr B W Fleck, Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh EH3 9HA, UK; brian.fleck{at}


Aim: To compare the diagnostic accuracy of wide-field digital retinal imaging (WFDRI) with the current “gold standard” of binocular indirect ophthalmoscopy (BIO) for retinopathy of prematurity (ROP) screening examinations.

Methods: A consecutive series of premature infants undergoing ROP screening at Edinburgh Royal Infirmary were eligible for recruitment into this prospective, randomised, comparative study. Infants were screened using both WFDRI (Retcam II with neonatal lens) and BIO by two paediatric ophthalmologists who were randomised to the examination technique. Both examiners documented their clinical findings and management plans in a masked fashion. WFDRI eye findings were compared with those of BIO.

Results: A total of 81 infants were recruited, and information from 245 eye examinations was analysed. The sensitivity of WFDRI in detecting any stage of ROP, stage 3 ROP and “plus” disease was 60%, 57% and 80%, respectively, and specificity 91%, 98% and 98%, respectively. The proportional agreement between WFDRI and BIO was 0.96 for detecting stage 3 disease and 0.97 for detecting “plus” disease. There was very good agreement on management decisions (kappa 0.85).

Conclusion: When used in a routine ROP screening setting, a randomised comparison of WFDRI and BIO, WFDRI showed relatively poor sensitivity in detecting mild forms of ROP in the retinal periphery. This resulted in difficulty in making decisions to discharge infants from the screening programme. Sensitivity was better for more severe forms of ROP, but at present WFDRI should be regarded as an adjunct to, rather than a replacement for, BIO in routine ROP screening.

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  • Funding: None of the authors has any financial interest in, or has received any form of funding from, the manufacturers or suppliers of the Retcam camera system. CD salary: Piggybank kids Trust; Equipment: Eyecare; Edinburgh Sick Kids Friends. Foundation; Edinburgh “Baby Ball.”

  • Competing interests: None.

  • Ethics approval: Ethics approval was provided by Lothian Research Ethics Committee.

  • Patient consent: Obtained from the parents.

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