The Utility of Non-ophthalmologist Examination of Eyes at Risk for Serious Retinopathy of Prematurity

Abstract

Background: Retinopathy of Prematurity (ROP) is the main cause of preventable blindness in premature babies. Currently, there is a shortage of trained ophthalmologists, which has resulted in an alarming increase in cases of vision loss and related complications. This study’s aim was to determine the utility of examinations conducted by non-ophthalmologist physicians to assess posterior pole vessel abnormalities in eyes at risk for ROP.

Method: Non-ophthalmologist physicians (pediatrician and neonatologist) were trained to use an indirect ophthalmoscope to view the posterior pole of babies at risk for ROP. Examinations were conducted on both eyes of premature infants born before 35 weeks gestational age (GA) starting at the third week after birth and weekly thereafter. The presence of Plus disease was identified by the non-ophthalmologist and results compared to the clinical examination by a pediatric ophthalmologist experienced in ROP detection and treatment. Chi-square was used for proportions and the Mann Whitney U test for medians. Fagan’s nomogram was determined for diagnostic usability. The Kappa index was used to rate inter-observer agreement.

Results: Results of 228 examinations performed on 150 premature infants were analyzed to determine the correlation of the non-ophthalmologist findings and the eye examination. For any vascular change in posterior pole diagnostic, findings were 87% and 87% accuracy for pediatrician and neonatologist, 82% and 83% sensitivity, 90% and 90% specificity respectively. There was no significant difference found in the detection of Plus disease for the examinations performed by the ophthalmologist compared to those performed by the non-ophthalmologist (P < 0.05).

Conclusions: After training in the use of an indirect ophthalmoscope, non-ophthalmologist physicians can reliably detect posterior pole retinal vessel changes for ROP diagnosis.

Keywords::

• Retinopathy of prematurity detection
• Blindness prevention
• Plus disease
• Non-ophthalmologist

ACKNOWLEDGMENTS

This study reports on the usefulness of indirect ophthalmoscopies performed by non-ophthalmologist medical personnel and is part of the “No More Blind Children” program headed by the author in the state of Jalisco, Mexico, where at-risk newborn infants are examined by previously trained medical personnel in neonatal intensive care units in five public secondary care facilities lacking the services of an ophthalmologist.

We would like to thank Dr Graham Quinn for his contribution to the preparation of this manuscript.

Declaration of Interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.