Elsevier

Ophthalmology

Volume 113, Issue 9, September 2006, Pages 1547-1552
Ophthalmology

Original Article
Impact of Retinopathy of Prematurity Screening Examination on Cardiorespiratory Indices: A Comparison of Indirect Ophthalmoscopy and Retcam Imaging

Presented in part at: Association for Research in Vision and Ophthalmology Annual Meeting, May 2005, Ft. Lauderdale, Florida, and Royal College of Ophthalmologists Annual Congress, May 2005, Birmingham, United Kingdom.
https://doi.org/10.1016/j.ophtha.2006.03.056Get rights and content

Purpose

To compare the impact of retinopathy of prematurity (ROP) screening examination between a digital fundus camera and conventional binocular indirect ophthalmoscopy (BIO) using cardiorespiratory indices as a measure of distress.

Design

Prospective comparative (nonrandomized) interventional study.

Participants

Eighty-six preterm infants with a birth weight of ≤1500 g or gestational age of ≤32 weeks and undergoing ROP screening were included.

Methods

Retinopathy of prematurity screening examination with BIO or the digital fundus camera was performed. Cardiovascular indices were recorded before, during, and 1 hour after examination. Race, birth weight, gender, twin status, duration of the examination, gestational age, and postconceptual age were recorded.

Main Outcome Measures

Heart rate (HR), oxygen saturation, respiratory rate (RR), and mean blood pressure (BP).

Results

Thirty-four infants underwent indirect ophthalmoscopy, whereas 52 underwent digital fundus camera examination. The increase in HR and RR was significantly higher in the indirect ophthalmoscopy group than in the digital fundus camera group (P<0.05). There was a significant increase in HR and mean BP during examination in both groups (P<0.05). No clinically significant response persisted at 1 hour. Digital fundus camera examination took significantly longer (P<0.001).

Conclusions

Screening for ROP with a digital fundus camera is associated with a significantly lower stress-related response than conventional indirect ophthalmoscopy.

Section snippets

Materials and Methods

This was a prospective nonrandomized study with local ethics committee approval. The study population consisted of all consecutive infants undergoing ROP screening during a 15-month study period at 2 neonatology units. In keeping with United Kingdom screening criteria, the inclusion criteria were all infants born at or before 32 weeks’ gestation, or who weighed ≤1500 g.3 Before inclusion, informed parental consent was obtained. All infants examined at one unit underwent Retcam examination,

Results

During the study period, data were collected for a total of 107 patients. Four were excluded due to missing data. Of the remainder, 67 were in the Retcam group and 36 in the BIO group. The 2 groups were heterogeneous with regard to disease severity, with 2 severe cases of 36 in the BIO group, compared with 15 of 67 in the Retcam group (P = 0.012, Fisher exact test). Hence, severity 1 (more severe) cases were excluded to validate comparative analysis. This left 52 cases in the Retcam group and

Discussion

The results of this study suggest that there is a significant impact on cardiorespiratory indices in preterm infants screened for ROP with both techniques of examination. Screening with the Retcam, however, was associated with a reduced stress response when compared with BIO, even though the length of examination was longer with the Retcam.

Laws et al found a significant rise in HR and systolic and diastolic BP as well as a significant fall in oxygen saturation in a cohort of 56 infants

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    Manuscript no. 2005-1112.

    No author has a financial interest related to the article.

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