CAN NON-OPHTHALMOLOGISTS SCREEN FOR RETINOPATHY OF PREMATURITY

Background: Dilation and tortuosity of the posterior pole vessels (''p lus disease'') is a poor prognostic sign and may indicate the presence of threshold or pre-threshold retinopathy of prematurity (ROP). Becau se stage 3 ROP appears rarely in the absence of posterior pole vascula r abnormalities, we prospectively evaluated the ability of non-ophthal mologists (4th-year medical students, pediatric residents, and nurse p ractitioners) to identify abnormalities in the retinal blood vessels o f infants undergoing examinations for ROP. Methods: Fifty infants weig hing less than 1600 g at birth were examined between 32 and 40 weeks a fter conception. Prior to ophthalmological examination, non-ophthalmol ogist examiners graded posterior pole vessels as normal or abnormal ba sed on ophthalmoscopic appearance. One hundred twenty-one ocular exami nations were performed using the teaching mirror of the indirect ophth almoscope, 179 using the direct ophthalmoscope. The indirect ophthalmo scopy was performed simultaneously by an ophthalmologist who evaluated the posterior pole vessels for abnormalities prior to conducting a pe ripheral fundus examination on either eye. Results: Testing sensitivit y for the non-ophthalmologist examiners using direct and indirect opht halmoscopy was 96% and 92%, respectively. Combining the results from d irect and indirect ophthalmoscopy, the Clopper-Pearson 95% sensitivity confidence interval for identifying abnormal arterioles and venules w as 82% to 99%, with a point estimate of 95%. Conclusion: These data su ggest that non-ophthalmologist examiners can detect posterior pole vas cular abnormalities in premature infants. If properly trained, they co uld possibly play a role in screening or follow-up examinations for RO P.