Abstract
Objective: The aim of the present study is to determine the efficiency of third year ophthalmology residents from a tertiary hospital in performing preliminary retinal examination to identify eyes at risk retinopathy of prematurity on the basis of retinal fundus findings up to International Classification of Retinopathy of Prematurity (ICROP) Zone II. Methods: This is a single-center, cross-sectional, prospective comparative research conducted from June to October 2015 at a tertiary training hospital in the Philippines. All infants referred for retinopathy of prematurity screening within the study period where included. The presence of retinal vessel dilatation and tortuosity were identified by third year ophthalmology residents using indirect funduscopy. The residents’ fundus findings were then compared to that of a retina consultant who is proficient in the diagnosis and management of retinopathy of prematurity (ROP). The Kappa index was used to rate inter-observer agreement. The correlation between ROP risk factors and the presence of abnormal retinal vessels were assessed using odd ratio computations. Fisher’s exact test was used to determine the correlation between retinopathy of prematurity and the presence of retinal dilatation and tortuosity. The McNemar’s test was also applied to determine significant differences in the retinal findings of the consultant and ophthalmology residents. Results: A total of 82 eyes of 41 premature infants were evaluated to determine if retinal findings observed by ophthalmology residents were comparable to that of a retina consultant. Odds ratios show that age of gestation, birth weight, and history of blood transfusion are significantly associated with the presence of retinopathy of prematurity. Retinal vessel tortuosity and dilatation are also more common among infants diagnosed with retinopathy of prematurity. There was no significant difference between the retinal vascular findings of the retina consultant and the third year ophthalmology resident in terms of identifying retinal vessel dilatation and tortuosity (P < 0.05). Conclusion: After sufficient and in-depth ophthalmology training, third year ophthalmologists, who will be general ophthalmologists in the future, can reliably identify eyes at risk for severe retinopathy of prematurity on the basis of retinal vascular dilatation and/or tortuosity.
Highlights
Retinopathy of prematurity (ROP) is a proliferative retinal vascular disorder primarily affecting premature or low birth weight infants.1With advancements in neonatal care and increasing survival of preterm infants, there is a parallel increase in the incidence of ROP worldwide
Numerous studies have shown that blindness as a result of neglected retinopathy of prematurity is preventable when treatment is done at the appropriate time.5Some management options for those with ROP include laser photocoagulation, injection of anti-vascular endothelial growth factor (VEGF), and cryotherapy.[5]
Demographics and Risk Factors of Preterm Infants Examined for Retinopathy of Prematurity
Summary
Retinopathy of prematurity (ROP) is a proliferative retinal vascular disorder primarily affecting premature or low birth weight infants.1With advancements in neonatal care and increasing survival of preterm infants, there is a parallel increase in the incidence of ROP worldwide. Retinopathy of prematurity accounts for 6-18% of irreversible childhood blindness in both developed and developing countries.[2] Based on the statistics provided by the World Health Organization (WHO), more than half of the estimated 1.5 million blind children in the world are in Asia.[3] In the Philippines, almost half a million Filipinos suffer from blindness and fifty percent of them are known to be from a preventable or treatable cause such as ROP.[3] it has been reported that 8.4% of children attending a school for the blind in the Philippines have severe visual impairment secondary to ROP.[4]. Numerous studies have shown that blindness as a result of neglected retinopathy of prematurity is preventable when treatment is done at the appropriate time.5Some management options for those with ROP include laser photocoagulation, injection of anti-VEGF, and cryotherapy.[5] The proven benefit of these treatment modalities has made it imperative for all susceptible infants to undergo routine screening by an ophthalmologist trained in the evaluation and management of ROP. The proven benefit of these treatment modalities has made it imperative for all susceptible infants to undergo routine screening by an ophthalmologist trained in the evaluation and management of ROP. 5
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