Predictive value of temporal retinal disease in retinopathy of prematurity.

Abstract

Screening examinations for retinopathy of prematurity (ROP) can be stressful to the premature infant. The temporal retina is the most easily visualized area of the peripheral retina. This study was undertaken to determine whether evaluation of the temporal peripheral retina provides a reliable indicator of the ROP status of the entire retina. A total of 690 ROP eye examinations were performed on 156 premature infants. Eye examinations of 95 patients were reviewed retrospectively and of 61 patients prospectively. All patients were born at less than 34 weeks estimated gestational age (EGA) and had a birth weight less than 1600 g. No examinations were performed prior to 4 weeks of age. Each eye examination was considered independently. The fundus examination was recorded using the International Classification of Retinopathy of Prematurity. The temporal four clock hours of retina were classified as the "temporal" retina. The remainder of the peripheral retina was classified as "nontemporal." A highly significant correlation (Pearson correlation coefficient = 0.88) between the severity (ie, stage) of temporal ROP and the severity of nontemporal ROP was noted. The status of temporal ROP was found to be more advanced or the same as nontemporal retina in 91.2% of the examinations. Nontemporal disease was found to be more severe than temporal disease in 8.8% of the examinations, but only 0.4% of examinations indicated nontemporal disease that was worse than temporal disease by more than one stage. The temporal retinal disease status in ROP is strongly predictive of the disease status of the entire retina. An abbreviated retinal examination of the temporal clock hours provides a reliable indicator of the highest stage of ROP present in the entire retina. Such a screening examination, although not recommended for routine screening, may be useful when a complete ROP examination cannot be performed because of physiologic instability or poor visibility.