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Nguyen TAL, Raileanu V, Smith B, Griffin A, Shah S. Excellent accuracy of trained neonatal nurses in the detection of referral-warranted retinopathy of prematurity within an established telemedicine screening programme. J Paediatr Child Health 2024; 60:369-374. [PMID: 39034445 DOI: 10.1111/jpc.16621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
AIM To evaluate level of agreement of specialist trained retinopathy of prematurity (ROP) nurses compared with an experienced paediatric ophthalmologist in detection of referral-warranted ROP (RWROP) using wide-field digital retinal imaging. METHODS This is a prospective, observational, blinded study of neonates in a level III neonatal intensive care unit, from July 2020 to November 2022. Image capture using wide-field digital retinal imaging followed by ROP grading and staging was completed by trained ROP nurses. This was then compared with findings by an experienced paediatric ophthalmologist. The primary outcome was presence of RWROP in either eye. RESULTS One hundred and ninety-five neonates (55% male) with a total of 768 screening visits were included. At the initial screen, nurse and ophthalmologist agreed about presence of RWROP for 191 of 195 neonates (98%, kappa = 0.79, P < 0.0001), with 100% sensitivity for RWROP detection. Including all 768 screening episodes, agreement was 98% for RWROP. There was disagreement in 16 screenings (2%) for 11 (6%) neonates. Of the five screenings (0.7%) that the ophthalmologist thought were RWROP and the nurse did not, three were disagreements about whether the zone was posterior zone 2 or zone 1. CONCLUSIONS We found excellent levels of agreement and add evidence that interpretations by specialist trained nurses could be safely integrated into a 'hybrid ROP screening system'.
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Affiliation(s)
- Thuan Anh Le Nguyen
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Vanessa Raileanu
- Neonatal Critical Care Unit, Mater Mothers' Hospitals, Brisbane, Queensland, Australia
| | - Bernice Smith
- Neonatal Critical Care Unit, Mater Mothers' Hospitals, Brisbane, Queensland, Australia
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Shaheen Shah
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
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Ramanathan A, Athikarisamy SE, Lam GC. Artificial intelligence for the diagnosis of retinopathy of prematurity: A systematic review of current algorithms. Eye (Lond) 2023; 37:2518-2526. [PMID: 36577806 PMCID: PMC10397194 DOI: 10.1038/s41433-022-02366-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/OBJECTIVES With the increasing survival of premature infants, there is an increased demand to provide adequate retinopathy of prematurity (ROP) services. Wide field retinal imaging (WFDRI) and artificial intelligence (AI) have shown promise in the field of ROP and have the potential to improve the diagnostic performance and reduce the workload for screening ophthalmologists. The aim of this review is to systematically review and provide a summary of the diagnostic characteristics of existing deep learning algorithms. SUBJECT/METHODS Two authors independently searched the literature, and studies using a deep learning system from retinal imaging were included. Data were extracted, assessed and reported using PRISMA guidelines. RESULTS Twenty-seven studies were included in this review. Nineteen studies used AI systems to diagnose ROP, classify the staging of ROP, diagnose the presence of pre-plus or plus disease, or assess the quality of retinal images. The included studies reported a sensitivity of 71%-100%, specificity of 74-99% and area under the curve of 91-99% for the primary outcome of the study. AI techniques were comparable to the assessment of ophthalmologists in terms of overall accuracy and sensitivity. Eight studies evaluated vascular severity scores and were able to accurately differentiate severity using an automated classification score. CONCLUSION Artificial intelligence for ROP diagnosis is a growing field, and many potential utilities have already been identified, including the presence of plus disease, staging of disease and a new automated severity score. AI has a role as an adjunct to clinical assessment; however, there is insufficient evidence to support its use as a sole diagnostic tool currently.
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Affiliation(s)
- Ashwin Ramanathan
- Department of Paediatrics, Perth Children's Hospital, Perth, Australia
| | - Sam Ebenezer Athikarisamy
- Department of Neonatology, Perth Children's Hospital, Perth, Australia.
- School of Medicine, University of Western Australia, Crawley, Australia.
| | - Geoffrey C Lam
- Department of Ophthalmology, Perth Children's Hospital, Perth, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Crawley, Australia
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3
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Ducloyer JB, Scherpereel C, Goronflot T, Le Meur G, Lebranchu P, Jossic F, Scolan V, Ducloyer M. Assessing retinal hemorrhages with non-invasive post-mortem fundus photographs in sudden unexpected death in infancy. Int J Legal Med 2023; 137:913-923. [PMID: 36823412 PMCID: PMC10085933 DOI: 10.1007/s00414-023-02964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION In the case of sudden unexpected death in infancy (SUDI), eye examination is systematic to detect retinal hemorrhages (RH) that are a crucial hallmark for abusive head trauma (AHT). The aim of this study is to assess the ability of non-invasive post-mortem fundus photographs (PMFP) to detect RH in case of SUDI. METHODS Bicentric retrospective analysis of consecutive cases of SUDI under 2 years of age were managed by two French SUDI referral centers with PMFP by RetCam (Clarity Medical Systems USA). PMFP were reviewed randomly, twice, by three independent ophthalmologists blinded for clinical data. RESULTS Thirty cases (60 eyes) were included. Median age was 3.5 months (interquartile [1.6; 6.0]). No child died of AHT. Image quality was sufficient to assert presence or absence of RH in 50 eyes (83%). Sufficient quality rate was significantly higher when the post-mortem interval was inferior to 18 h (91%, 42/46) as opposed to over 18 h (57%, 8/14, p=0.0096). RH were found in six eyes (10%), four children (13%), with excellent inter and intra-raters' concordance (Cohen's Kappa from 0.81 [0.56-1.00] to 1.00 [1.00-1.00]). CONCLUSION PMFP can detect RH in case of SUDI and is a relevant systematic screening test to be carried out as soon as the deceased child arrives in the hospital. It can decrease the need of eye removal for pathological examination, but further studies are needed to define the best decision algorithm.
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Affiliation(s)
| | | | - Thomas Goronflot
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000, Nantes, France
| | - Guylène Le Meur
- Nantes Université, CHU Nantes, service d'ophtalmologie, Nantes, France
| | - Pierre Lebranchu
- Nantes Université, CHU Nantes, service d'ophtalmologie, Nantes, France
| | | | | | - Mathilde Ducloyer
- Nantes Université, CHU Nantes, service de médecine légale, Nantes, France.,Nantes Université, CHU Nantes, INSERM, CIC 1413, 44000, Nantes, France
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4
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Machin HM, Daniell M, Entwistle LI, Hafner C, Huigen A, Kaur H, McCulloch J, Osadchiy M. A Scoping Review on Determining Australian Nurse Engagement in Eye Care Settings. Clin Ophthalmol 2023; 17:393-401. [PMID: 36748047 PMCID: PMC9899019 DOI: 10.2147/opth.s391734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/08/2022] [Indexed: 02/03/2023] Open
Abstract
Purpose As the Australian population grows and ages, the demand for eye care services, and nurses to provide the services, is expected to increase. This will impact nurses, who are Australia's largest health-care provider group. Understanding and mapping the current role and use of nurses in eye care is an essential first step for future health workforce planning and development. To map their engagement, we undertook a scoping review to gain an understanding of the current Australian nurse eye care workforce landscape, to help guide and support future workforce development activities. Secondly, we evaluated if publications in this field incorporated or mentioned the Australian Ophthalmic Nursing Association's National Standards (Practice standards) in their publication. This review also offers other nations and eye care providers the opportunity to evaluate their own health workforce plan and nurse utility. Study Design and Methods We conducted a review of academic and grey literature, via various search engines, and an inclusion and exclusion criteria. Results We uncovered 11 publications. Of those, five were academic papers examining extended and advanced nursing practice, one was a letter to the editor, two were industry feature reviews, two were industry reports and the final was the Practice Standards. Key themes throughout indicated the benefit of nurse training and nurse involvement in eye care. Overall, there was insufficient information or data to describe nurse deployment, practice and utility. Finally, the Practice Standards were not referenced in any publication. Conclusion There is insufficient published information to calculate the level and involvement of nurses, or describe their existing role, advancement or future deployment in eye care in Australia. Without clear information, Australia is unable to develop effective health workforce strategies to attract, train, retain, and appropriately deploy nurses to meet future eye care needs.
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Affiliation(s)
- Heather M Machin
- Surgical Research Unit, Centre for Eye Research Australia, Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Australia,Royal Victorian Eye and Ear Hospital, Melbourne, Australia,Correspondence: Heather M Machin, Email
| | - Mark Daniell
- Surgical Research Unit, Centre for Eye Research Australia, Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Australia,Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Lauren I Entwistle
- Ophthalmology Outpatients Department, Royal Perth Hospital, Perth, Australia
| | - Clare Hafner
- Ophthalmology Outpatients Department, Sydney Hospital and Sydney Eye Hospital, South East Sydney Local Health District, Sydney, Australia
| | - Anna Huigen
- Primary and Public Health Care Urban, NT Health – Central Australia, Melbourne, Australia
| | - Harsimrat Kaur
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Joanna McCulloch
- Ophthalmology Outpatients Department, Sydney Hospital and Sydney Eye Hospital, South East Sydney Local Health District, Sydney, Australia,Nursing Education, Research and Leadership Unit, Sydney Hospital and Sydney Eye Hospital, South East Sydney Local Health District, Sydney, Australia,School of Nursing and Midwifery, Notre Dame University, Sydney Campus University of Notre Dame, Sydney, Australia
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Ripa M, Motta L, Florit T, Sahyoun JY, Matello V, Parolini B. The Role of Widefield and Ultra Widefield Optical Coherence Tomography in the Diagnosis and Management of Vitreoretinal Diseases. Diagnostics (Basel) 2022; 12:diagnostics12092247. [PMID: 36140648 PMCID: PMC9497586 DOI: 10.3390/diagnostics12092247] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: This study reports on the advantages of wide-field (WF)- and ultra-widefield (UWF)- optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in managing different vitreoretinal diseases in a real-life setting using the new WF—Swept Source (SS)—OCT Xephilio S1 (Canon, Tokyo, Japan). Methods: We conducted an observational retrospective case series study involving 1472 eyes that underwent retinal scans with Canon Xephilio® OCT-S1 between 1 March 2021 and 1 December 2021 at Eyecare Clinic (Brescia, Italy). All patients underwent routine ophthalmologic examinations along with WF and UWF color fundus retinography with Clarus 500™ (Carl Zeiss Meditec, Inc., Dublin, CA, USA) and Xephilio® OCT-S1. WF SS-OCT, UWF-OCT, WF-OCTA, and UWF-OCTA were taken by using Xephilio® OCT-S1. Results: We analyzed 122 peripheral retinal lesions, 144 retinal detachment, 329 high myopic eyes, 37 pediatric cases, 60 vascular retinopathies, 15 choroidal lesions, and 90 eyes as follow-up post vitreoretinal surgery. The OCT-S1 was the only reliable and diagnostic exam for peripheral lesions, pediatric and high myopic cases, and significantly influenced the management in 10% of cases and the postoperative follow-up. Conclusions: WF and UWF OCT and OCTA imaging may help in the management of several vitreoretinal diseases, becoming an indispensable tool for the high-quality management of patients.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Ophthalmology Unit, Catholic University “Sacro Cuore”, 00168 Rome, Italy
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK
- Correspondence:
| | - Teresa Florit
- Department of Ophthalmology, Eyecare Clinic, 25124 Brescia, Italy
| | - Jean-Yves Sahyoun
- Department of Ophthalmology, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Department of Ophthalmology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada
| | - Veronika Matello
- Department of Ophthalmology, Eyecare Clinic, 25124 Brescia, Italy
| | - Barbara Parolini
- Department of Ophthalmology, Eyecare Clinic, 25124 Brescia, Italy
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Haefeli LM, Neves LM, Zin A, Costa ACC, Farias Meira de Vasconcelos Z, Pinto M. Portable wide-field digital imaging for screening of neonatal visual impairment causes in Rio de Janeiro, Brazil: a budget impact analysis. BMJ Open 2022; 12:e056498. [PMID: 35688584 PMCID: PMC9189816 DOI: 10.1136/bmjopen-2021-056498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the budget impact of portable wide-field digital imaging incorporation on screening neonatal causes of childhood blindness and visual impairment in Rio de Janeiro, Brazil. DESIGN Budget impact analysis. SETTING Rio de Janeiro, Brazil. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the direct cost of indirect binocular ophthalmoscopy, red reflex test and portable wide-field digital image screening comprising all babies born in Rio de Janeiro's government maternity wards. The secondary outcome was the budget impact of implementing portable wide-field digital image screening in Rio de Janeiro, Brazil. RESULTS Considering 100% coverage of maternity wards, the total budget impact between 2020 and 2024 would be US$3 820 706.04, ranging from US$3 139 844.34 to US$6 099 510.35. The additional cost would be US$3 124 457.28, ranging from US$2 714 492.26 to US$4 880 608.63. CONCLUSION The cost of universal digital imaging screening corresponds to less than 1% of the government health budget of the city of Rio de Janeiro. The information provided in this study may help government decision-makers evaluate the feasibility of implementing this new strategy in the municipal setting. Further health economic evaluations should be performed to verify the affordability of the implementation of this screening strategy in the Brazilian scenario, taking into account scarce human resources.
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Affiliation(s)
- Lorena M Haefeli
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luiza M Neves
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Andrea Zin
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Carolina Carioca Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Marcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Ravelo J, Adams G, Husain S. Identification of treatment-warranted retinopathy of prematurity by neonatal nurse specialist. Arch Dis Child Fetal Neonatal Ed 2022; 107:299-302. [PMID: 34426506 DOI: 10.1136/archdischild-2021-322266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the accuracy in the identification of infants with treatment-warranted retinopathy of prematurity (ROP) by a trained and experienced ROP neonatal nurse specialist compared with skilled ophthalmologists. METHODS A single-centre, prospective, blinded, agreement study was performed on a cohort of infants undergoing ROP screening. An experienced ROP neonatal nurse specialist obtained retinal images using a wide field digital retinal imaging system (WFDRI) on 127 infants and identified those with treatment-warranted ROP. This interpretation was compared with the interpretation of the same images by skilled ophthalmologists. The accuracy of the ROP nurse specialist's interpretation was assessed for sensitivity and specificity compared with the gold standard interpretation by the ophthalmologists. RESULTS The ROP nurse specialist performed 345 ROP screens on both eyes of 127 infants. The mean (SD) gestation age (weeks) and birth weight (g) of the infants screened was 26.8 (2.8) and 929 (327), respectively. The nurse specialist correctly identified all 8 infants with treatment-warranted ROP and 118/119 infants without. The sensitivity and specificity (95% CI) of ROP screening episodes were 100% (63% to 100%) and 99.7% (98.4% to 100.0%), respectively. CONCLUSION A trained and experienced ROP neonatal nurse specialist can correctly identify infants with treatment-warranted ROP using WFDRI. Further work is required to examine the generalisability of this finding and its impact on ROP screening services.
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Affiliation(s)
- Janette Ravelo
- Neonatology Department, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Gillian Adams
- Strabismus and Paediatric Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Shahid Husain
- Neonatology Department, Homerton University Hospital NHS Foundation Trust, London, UK .,Genetics and Child Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
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8
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Karunatilake M, Daspal S, Mugarab Samedi V, Rubab S. Screening for Retinopathy of Prematurity Through Utilization a Pediatric Retinal Camera at Jim Pattison Children's Hospital: A Vision for Improved Care. Glob Pediatr Health 2021; 8:2333794X211039642. [PMID: 34616858 PMCID: PMC8488407 DOI: 10.1177/2333794x211039642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022] Open
Abstract
Retinopathy of Prematurity (ROP) is a vascular proliferative disorder of preterm infants,
with increased disease severity and incidence occurring with lower gestational age and
birth weight. An alternate approach to ROP screening with wide-field digital retinal
imaging helps with the early detection of ROP, especially during the pandemic.
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Affiliation(s)
- Malshi Karunatilake
- University of Saskatchewan, Saskatoon, SK, Canada.,Royal University Hospital Children's Services, Saskatoon, SK, Canada
| | - Sibasis Daspal
- University of Saskatchewan, Saskatoon, SK, Canada.,Royal University Hospital Children's Services, Saskatoon, SK, Canada
| | - Veronica Mugarab Samedi
- University of Saskatchewan, Saskatoon, SK, Canada.,Royal University Hospital Children's Services, Saskatoon, SK, Canada
| | - Shehla Rubab
- University of Saskatchewan, Saskatoon, SK, Canada.,Royal University Hospital Children's Services, Saskatoon, SK, Canada
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Dhami A, Gupta G, Dhami NB, Arora N, Dhami GS. Analysis of the parental satisfaction for retinopathy of prematurity screening using binocular indirect ophthalmoscopy versus wide field retinal imaging. Indian J Ophthalmol 2021; 69:2142-2145. [PMID: 34304196 PMCID: PMC8482935 DOI: 10.4103/ijo.ijo_3705_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Analysis of the parental satisfaction for retinopathy of prematurity screening using binocular indirect ophthalmoscopy versus wide field retinal imaging. Methods: This was an observational, questionnaire survey-based study. The study cohort comprised of parents/legal guardians of consecutive Asian Indian premature infants enrolled for retinopathy of prematurity screening (for infants less than 2000 gms and/or 34-weeks gestational age) using binocular indirect ophthalmoscopy (BIO) with scleral depression and b) wide field retinal imaging using the 3Nethra Neo Camera (Forus Health, India). We evaluated the retina for the presence or absence of stages of ROP and plus disease. The survey analysis used closed-ended (multiple-choice) and open-ended questions for assessing 1) parents’ experience/preference among the two screening modalities namely, BIO and wide field imaging used in the study, 2) knowledge prior to ROP screening, 3) knowledge gained post ROP screening, in the outpatient ophthalmologic care unit in our hospital. Results: Parents/legal guardians of 90 infants were included in the study. Among the 90 parents who filled in the questionnaire, 62.3% were referred by their pediatrician, 23.3% came for self check-up and 14.4% incidentally came to the hospital for complaints like ocular discharge and were screened. 93.3% parents were satisfied with either ROP screening modality in our study, with 54.4% stated a preference for retinal imaging. In the study 20% of the parents felt that retinal imaging was painful for the infant and 31.1% felt that BIO was painful for the infant. Conclusion: Wide field imaging is increasingly becoming an effective tool and screening tool in ROP screening and helps in better understanding of the disease amongst parents.
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Affiliation(s)
- Abhinav Dhami
- Consultant Vitreo-Retina, Dhami Eye Care Hospital, Ludhiana, Punjab, India
| | - Gaurav Gupta
- Consultant, Garg Hospital, Ludhiana, Punjab, India
| | - Nimrata Bajaj Dhami
- Consultant Cataract, Refractive and Cornea, Dhami Eye Care Hospital, Ludhiana, Punjab, India
| | - Nishant Arora
- Optometrist, Dhami Eye Care Hospital, Ludhiana, Punjab, India
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