title: 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.
  
  
  METHODS
  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.
authors: Department of Retinopathy of Prematurity and Blindness Prevention, Hospital Civil de Guadalajara, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico. drconsuelo@yahoo.com
authors: Luz Consuelo
authors: LC
authors: Zepeda-Romero
authors: Juan Carlos
authors: JC
authors: Barrera-de-León
authors: Cesareo
authors: C
authors: González-Bernal
authors: Mario
authors: M
authors: Marquez-Amezcua
authors: Verónica
authors: V
authors: Diaz-Arteaga
authors: Eusebio
authors: E
authors: Angulo-Castellanos
authors: Jose Alfonso
authors: JA
authors: Gutiérrez-Padilla
authors: Hector
authors: H
authors: Gallardo-Rincón
mesh_terms: D016009:Chi-Square Distribution; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008800:Mexico; D015997:Neonatal Screening / Q000379:methods*; D009359:Neonatology / Q000379:methods; D009887:Ophthalmoscopy / Q000379:methods; D010372:Pediatrics / Q000379:methods; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D018709:Statistics, Nonparametric