Major article
RetCam Imaging for Retinopathy of Prematurity Screening

Presented at the 30th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Washington, DC, March 27-31, 2004.
https://doi.org/10.1016/j.jaapos.2005.11.019Get rights and content

Purpose: Indirect ophthalmoscopy is the gold standard for retinopathy of prematurity (ROP) screening. Screening for ROP with digital imaging has been proposed as a possible alternative. Our goal was to evaluate the longitudinal clinical outcomes of employing digital imaging to detect high-risk ROP. Methods: Serial RetCam imaging and indirect ophthalmoscopy were performed on 43 premature infants. A masked reader evaluated the images and made management recommendations that were compared with indirect ophthalmoscopy results. Successful screening was determined by correctly identifying progression to prethreshold or threshold disease with referral for indirect ophthalmoscopy. Unsuccessful screening was determined by failure to identify prethreshold or threshold disease, inaccurately detecting prethreshold or threshold disease, or inability to evaluate for ROP. Results: No cases of prethreshold or threshold disease were missed by the reader. The reader overestimated prethreshold or threshold disease in 5% of cases. Initial screening in 21% of cases could not be evaluated for ROP secondary to poor image quality. Digital photography had a sensitivity of 100% and specificity of 97.5% in detecting prethreshold and threshold ROP. Positive-predictive value of digital photography was 67% and negative-predictive value was 100%. Conclusions: Screening and management of ROP using RetCam imaging did not fail to detect prethreshold or threshold disease when images could be obtained. Ophthalmologic examinations were needed in 20% of cases that did not reach threshold or prethreshold disease because of poor image quality or overestimation of ROP. RetCam screening may safely reduce the overall number of indirect ophthalmologic examinations required.

Section snippets

Patients

Premature infants undergoing routine ROP screening examinations at Children’s Hospital Boston and Brigham and Women’s Hospital Neonatal Intensive Care Units (NICUs) were evaluated from August 2003 to January 2004. Screening guidelines for ROP at these two institutions included infants with gestational age (GA) less than 32 weeks, birth weight (BW) less than 1500 g, or older and heavier babies with an unstable clinical course who were believed to be at high risk for ROP by their attending

Results

ROP screening with RetCam imaging and indirect ophthalmoscopy was performed on 86 eyes of 43 infants. GA ranged from 23 to 33 weeks with a mean GA of 27.3 weeks. BW ranged from 460 to 2290 g with a mean weight of 1024 g. In this cohort, 42% of the infants developed ROP and 5% of infants required treatment.

No RetCam imaging had to be aborted secondary to patient stress. Initial images in 21% of cases could not be evaluated for ROP secondary to poor image quality (Figure 4). However, in 78% of

Discussion

With the advent of telemedicine and the decreasing number of ophthalmologists skilled in or available for examining infants for ROP, screening and management of ROP by digital imaging has been proposed. Previous studies have evaluated the sensitivity and specificity of detecting all stages of ROP and have shown that ROP in peripheral zone 2 or 3 was often missed in RetCam evaluations.6, 7, 8 Schwartz et al9 compared telemedical evaluation and management with traditional on-site evaluations of

References (12)

There are more references available in the full text version of this article.

Cited by (0)

View full text