Non-ophthalmologist screening for retinopathy of prematurity

Aim-To determine if a non-ophthalmologist can accurately screen for retinop athy of prematurity (ROP) by evaluating the posterior pole blood vessels of the retina. ROP is a common ocular disorder of premature infants and may r equire multiple screening examinations by an ophthalmologist to allow for t imely intervention. Since there is a strong correlation between posterior p ole vascular abnormalities and vision threatening ROP, screening examinatio ns performed by non-ophthalmologist may yield useful clinical information i n high risk infants. Methods-Infants born at the Medical University of South Carolina who met sc reening criteria (n = 142) were examined by a single non-ophthalmologist us ing a direct ophthalmoscope to evaluate the posterior pole blood vessels fo r abnormalities of the venules and/or arterioles. To determine the accuracy of the non-ophthalmologist's clinical observations, infants were also exam ined by an ophthalmologist, using an indirect ophthalmoscope, who graded th e posterior pole vessels as normal, dilated venules, or dilated and tortuou s venules and arterioles (including "plus disease". Results-There was significant correlation (p <0.001) between the non-ophtha lmologist's and ophthalmologist's diagnoses of posterior pole vascular abno rmalities. 47 infants had normal posterior pole blood vessels by the non-op hthalmologist examination. Of these, 31 (66%) were considered to have norma l vessels and 16 (34%) to have dilated venules by the ophthalmologist. The non-ophthalmologist correctly identified abnormal posterior pole vessels in all 21 infants diagnosed with abnormal arterioles and venules by the ophth almologist. No infants with clinically important ROP "prethreshold" or wors e) would have failed detection by this screening method. Conclusion-Using a direct ophthalmoscope, a non-ophthalmologist can screen premature infants at risk for ROP by evaluating the posterior pole blood ve ssels of the retina. While not necessarily recommended for routine clinical practice, this technique may nevertheless be of value to those situations where ophthalmological consultation is unavailable or difficult to obtain.