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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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Abstract

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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Abbreviations

BIO:

Binocular indirect ophthalmoscopy

GA:

Gestational age

PMA:

Postmenstrual age

ROP:

Retinopathy of prematurity

References

  1. Ludwig CA, Chen TA, Hernandez-Boussard T et al (2017) The epidemiology of retinopathy of prematurity in the United States. Ophthalmic Surg Lasers Imaging Retina 48:553–562. https://doi.org/10.3928/23258160-20170630-06

    Article  PubMed  Google Scholar 

  2. Painter SL, Wilkinson AR, Desai P et al (2015) Incidence and treatment of retinopathy of prematurity in England between 1990 and 2011: database study. Br J Ophthalmol 99:807–811. https://doi.org/10.1136/bjophthalmol-2014-305561

    Article  PubMed  Google Scholar 

  3. Beby F, Burillon C, Putet G, Denis Ph (2004) Rétinopathie du prématuré : résultats de l’examen du fond d’œil chez 94 enfants à risque. J Fr Ophtalmol 27:337–344. https://doi.org/10.1016/S0181-5512(04)96138-4

    Article  CAS  PubMed  Google Scholar 

  4. Austeng D (2009) Incidence of retinopathy of prematurity in infants born before 27 weeks’ gestation in Sweden. Arch Ophthalmol 127:1315. https://doi.org/10.1001/archophthalmol.2009.244

    Article  PubMed  Google Scholar 

  5. Slidsborg C, Forman JL, Rasmussen S et al (2011) A new risk-based screening criterion for treatment-demanding retinopathy of prematurity in Denmark. Pediatrics 127:e598–e606. https://doi.org/10.1542/peds.2010-1974

    Article  PubMed  Google Scholar 

  6. CRYO-ROP (2005) 15-year outcomes following threshold retinopathy of prematurity: final results from the multicenter trial of cryotherapy for retinopathy of prematurity. Arch Ophthalmol 123:311. https://doi.org/10.1001/archopht.123.3.311

    Article  Google Scholar 

  7. Good ETROP (2005) The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics 116:15–23. https://doi.org/10.1542/peds.2004-1413

    Article  PubMed  Google Scholar 

  8. Gilbert C (2008) Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Human Dev 84:77–82. https://doi.org/10.1016/j.earlhumdev.2007.11.009

    Article  Google Scholar 

  9. Chapron T, Caputo G, Pierrat V et al (2021) Screening for retinopathy of prematurity in very preterm children: the EPIPAGE-2 cohort study. Neonatology 118:80–89. https://doi.org/10.1159/000513225

    Article  PubMed  Google Scholar 

  10. Mills MD (2009) Retinopathy of prematurity malpractice claims. Arch Ophthalmol 127:803. https://doi.org/10.1001/archophthalmol.2009.117

    Article  PubMed  Google Scholar 

  11. Gilbert C, Wormald R, Fielder A et al (2016) Potential for a paradigm change in the detection of retinopathy of prematurity requiring treatment. Arch Dis Child Fetal Neonatal Ed 101:6–9. https://doi.org/10.1136/archdischild-2015-308704

    Article  Google Scholar 

  12. Barjol A, Lux A-L, Soudée S et al (2015) Recommandations françaises pour le dépistage de la rétinopathie des prématurés. In: Société française d’Ophtalmologie (SFO). Groupe d’Etude Français de la Rétinopathie du Prématuré (GEFROP). Association Française de strabologie et d’ophtalmologie pédiatrique (AFSOP)

  13. Denis D, Bui Quoc E, Aziz-Alessi A (2017) Ophtalmologie pédiatrique: rapport 2017 de la Société française d’ophtalmologie (SFO). Elsevier Masson, Issy-les-Moulineaux

  14. Fierson WM, American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology et al (2018) Screening examination of premature infants for retinopathy of prematurity. Pediatrics 142:e20183061. https://doi.org/10.1542/peds.2018-3061

  15. Ells AL, Holmes JM, Astle WF et al (2003) Telemedicine approach to screening for severe retinopathy of prematurity. Ophthalmology 110:2113–2117. https://doi.org/10.1016/S0161-6420(03)00831-5

    Article  PubMed  Google Scholar 

  16. Lorenz B, Spasovska K, Elflein H, Schneider N (2009) Wide-field digital imaging based telemedicine for screening for acute retinopathy of prematurity (ROP). Six-year results of a multicentre field study. Graefes Arch Clin Exp Ophthalmol 247:1251–1262. https://doi.org/10.1007/s00417-009-1077-7

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dhaliwal C, Wright E, Graham C et al (2009) Wide-field digital retinal imaging versus binocular indirect ophthalmoscopy for retinopathy of prematurity screening: a two-observer prospective, randomised comparison. Br J Ophthalmol 93:355–359. https://doi.org/10.1136/bjo.2008.148908

    Article  CAS  PubMed  Google Scholar 

  18. Dai S, Chow K, Vincent A (2010) Efficacy of wide-field digital retinal imaging for retinopathy of prematurity screening: retcam retinal imaging for ROP screening. Clin Experiment Ophthalmol. https://doi.org/10.1111/j.1442-9071.2010.02399.x

    Article  Google Scholar 

  19. Shah P, Narendran V, Saravanan V et al (2006) Screening for retinopathy of prematurity-a comparison between binocular indirect ophthalmoscopy and RetCam 120. Indian J Ophthalmol 54:35. https://doi.org/10.4103/0301-4738.21612

    Article  PubMed  Google Scholar 

  20. Quinn GE, Ying G, Daniel E et al (2014) Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity. JAMA Ophthalmol 132:1178. https://doi.org/10.1001/jamaophthalmol.2014.1604

    Article  PubMed  Google Scholar 

  21. PHOTO-ROP (2008) The photographic screening for retinopathy of prematurity study (PHOTO-ROP): primary outcomes. Retina 28:S47–S54. https://doi.org/10.1097/IAE.0b013e31815e987f

    Article  Google Scholar 

  22. Sekeroglu MA, Hekimoglu E, Sekeroglu HT, Arslan U (2013) Alternative methods for the screening of retinopathy of prematurity: binocular indirect ophthalmoscopy vs wide-field digital retinal imaging. Eye 27:1053–1057. https://doi.org/10.1038/eye.2013.128

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. iCROP (2005) The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 123:991. https://doi.org/10.1001/archopht.123.7.991

    Article  Google Scholar 

  24. Kim SJ, Port AD, Swan R et al (2018) Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol 63:618–637. https://doi.org/10.1016/j.survophthal.2018.04.002

    Article  PubMed  PubMed Central  Google Scholar 

  25. Shrestha N (2020) Detecting multicollinearity in regression analysis. Am J App Math Stat 8(2):39–42

  26. Wu C, Petersen RA, VanderVeen DK (2006) RetCam imaging for retinopathy of prematurity screening. J Pediatr Ophthalmol Strabismus 10:107–111. https://doi.org/10.1016/j.jaapos.2005.11.019

    Article  CAS  PubMed  Google Scholar 

  27. Wood EH, Moshfeghi AA, Nudleman ED, Moshfeghi DM (2016) Evaluation of Visunex Medical’s PanoCam™ LT and PanoCam ™ Pro wide-field imaging systems for the screening of ROP in newborn infants. Expert Rev Med Devices 13:705–712. https://doi.org/10.1080/17434440.2016.1208560

    Article  CAS  PubMed  Google Scholar 

  28. Silva RA, Murakami Y, Lad EM, Moshfeghi DM (2011) Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 36-month experience with telemedicine screening. Ophthalmic Surg Lasers Imaging 42:12–19. https://doi.org/10.3928/15428877-20100929-08

    Article  PubMed  Google Scholar 

  29. Mukherjee A, Watts P, Almadfai H et al (2006) Impact of retinopathy of prematurity screening examination on cardiorespiratory indicesa comparison of indirect ophthalmoscopy and Retcam imaging. Ophthalmology 113:1547–1552. https://doi.org/10.1016/j.ophtha.2006.03.056

    Article  PubMed  Google Scholar 

  30. Dhaliwal CA, Wright E, McIntosh N et al (2010) Pain in neonates during screening for retinopathy of prematurity using binocular indirect ophthalmoscopy and wide-fi eld digital retinal imaging: a randomised comparison. Arch Dis Child Fetal Neonatal Ed 95:F146–F148. https://doi.org/10.1136/adc.2009.168971

    Article  CAS  PubMed  Google Scholar 

  31. Moitry M, Zarca K, Granier M et al (2018) Effectiveness and efficiency of tele-expertise for improving access to retinopathy screening among 351 neonates in a secondary care center: an observational, controlled before-after study. PLoS ONE

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Contributions

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). https://doi.org/10.1007/s00431-023-04951-z

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