Can non-ophthalmologists screen for retinopathy of prematurity?
BACKGROUND
Dilation and tortuosity of the posterior pole vessels ("plus disease") is a poor prognostic sign and may indicate the presence of threshold or pre-threshold retinopathy of prematurity (ROP). Because stage 3 ROP appears rarely in the absence of posterior pole vascular abnormalities, we prospectively evaluated the ability of non-ophthalmologists (4th-year medical students, pediatric residents, and nurse practitioners) to identify abnormalities in the retinal blood vessels of infants undergoing examinations for ROP.


METHODS
Fifty infants weighting less than 1600 g at birth were examined between 32 and 40 weeks after conception. Prior to ophthalmological examination, non-ophthalmologist examiners graded posterior pole vessels as normal or abnormal based on ophthalmoscopic appearance. One hundred twenty-one ocular examinations were performed using the teaching mirror of the indirect ophthalmoscope, 179 using the direct ophthalmoscope. The indirect ophthalmoscopy was performed simultaneously by an ophthalmologist who evaluated the posterior pole vessels for abnormalities prior to conducting a peripheral fundus examination on either eye.


RESULTS
Testing sensitivity for the non-ophthalmologist examiners using direct and indirect ophthalmoscopy was 96% and 92%, respectively. Combining the results from direct and indirect ophthalmoscopy, the Clopper-Pearson 95% sensitivity confidence interval for identifying abnormal arterioles and venules was 82% to 99%, with a point estimate of 95%.


CONCLUSIONS
These data suggest that non-ophthalmologist examiners can detect posterior pole vascular abnormalities in premature infants. If properly trained, they could possibly play a role in screening or follow-up examinations for ROP.
N. Edgar Miles Center for Pediatric Ophthalmology, Storm Eye Institute, Medical University of South Carolina, Charleston 29425-2236, USA.
R A
RA
Saunders
E C
EC
Bluestein
J E
JE
Berland
M L
ML
Donahue
M E
ME
Wilson
P F
PF
Rust
D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007396:Internship and Residency; D009722:Nurse Practitioners; D009887:Ophthalmoscopy; D010372:Pediatrics; D010865:Pilot Projects; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D013337:Students, Medical