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Retinopathy of prematurity detection: a retrospective quality improvement project before-after implementation of retinal digital imaging for screening

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Screening of retinopathy of prematurity (ROP) was modified in a level-3 neonatal intensive care unit by the introduction of a wide-field retinal imaging. The aim of this study was to evaluate whether retinopathy of prematurity (ROP) diagnosis was improved or not compared to previously used binocular indirect ophthalmoscopy (BIO). This was a retrospective, uncontrolled, quality improvement project. Records of consecutive premature newborns screened for ROP over two 1-year periods were reviewed. Systemic factors potentially influencing the occurrence of ROP were investigated using uni- and multivariable linear regression followed by stepwise forward regression. ROP screening was performed by ophthalmologists using BIO in 2014, and digital wide-field retinal imaging (Panocam™ pro) in 2019. Records of N = 297 patients were analyzed (N = 159 in 2014 and N = 138 in 2019). The proportion of ROP diagnosed at any stage, over the total number of neonates screened, was significantly higher in 2019 (n = 46/138, 33.1%) compared to 2014 (n = 11/159, 6.9%) (p < 0.0001). Most neonates presented with mild forms of ROP during both 1-year periods analyzed. After adjustment for all parameters influencing ROP occurrence, the variables contributing independently to the diagnosis of any stage of ROP were birth weight (p = 0.002), duration of mechanical ventilation (p = 0.028) and wide-field fundus camera-assisted screening (p < 0.001).

Conclusion: After adjusting for many recognized systemic factors influencing the development of ROP, screening by wide-field digital retinal imaging was independently associated with higher ROP detection.

What is Known:

• No consensus has been reached to replace binocular indirect ophthalmoscopy by retinal imaging for ROP screening.

• Diagnostic accuracy and high sensitivity and specificity has been reported for wide-field digital imaging.

What is New:

• The introduction of wide-field imaging for ROP screening in at level-3 reference center was independently associated to higher ROP detection.

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Binocular indirect ophthalmoscopy


Gestational age


Postmenstrual age


Retinopathy of prematurity


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Authors and Affiliations



All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Marie-Gwenola Desurmont, Dominique Bremond-Gignac, Héloïse Torchin, Brigitte Vacherot, Pierre-Henri Jarreau, and Alejandra Daruich. The first draft of the manuscript was written by Marie-Gwenola Desurmont and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alejandra Daruich.

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This study was designed in accordance with the tenets of the Declaration of Helsinki and was approved by the Ethical Review Committee for publications of the Cochin University Hospital (CLEP Decision Number: AAA-2021-08067).

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The authors declare no competing interests.

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Communicated by Daniele De Luca.

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Desurmont, MG., Bremond-Gignac, D., Torchin, H. et al. Retinopathy of prematurity detection: a retrospective quality improvement project before-after implementation of retinal digital imaging for screening. Eur J Pediatr 182, 3093–3099 (2023).

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