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Screening for retinopathy of prematurity--a comparison between binocular indirect ophthalmoscopy and RetCam 120
Parag K Shah1, V Narendran, V R Saravanan
1Vitreo-Retinal Services, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India. drshahpk@vsnl.net
Insights
RetCam 120 photographic screening for retinopathy of prematurity (ROP) showed high sensitivity and specificity compared to binocular indirect ophthalmoscopy (BIO). While some early ROP cases were missed, no threshold ROP was missed, suggesting RetCam may replace BIO.
Area of Science:
- Ophthalmology
- Neonatology
- Medical Imaging
Background:
- Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature infants.
- Early detection and treatment are crucial to prevent vision loss.
- Binocular indirect ophthalmoscopy (BIO) is the current gold standard for ROP screening.
Purpose of the Study:
- To compare the diagnostic accuracy of RetCam 120 photographic screening with BIO for retinopathy of prematurity.
- To evaluate the sensitivity, specificity, and predictive values of RetCam 120 in ROP screening.
Main Methods:
- A prospective, comparative study involving 27 premature infants and 87 RetCam examinations.
- Simultaneous fundus evaluation using BIO by an experienced surgeon.
- Masked evaluation of RetCam photographs by a separate examiner.
Main Results:
- RetCam detected ROP in 56 out of 87 examinations, while BIO detected it in 63.
- RetCam demonstrated a sensitivity of 85.71% and specificity of 91.66%.
- No cases of threshold ROP were missed by RetCam.
Conclusions:
- RetCam 120 is a viable alternative for ROP screening, with high accuracy for significant disease.
- Missed ROP cases were primarily in early stages (zone 2/3) and regressed spontaneously.
- Limitations in camera mobility and speculum use affected detection of peripheral ROP.
Aim:
To compare the photographic screening for retinopathy of prematurity (ROP) using RetCam 120 with binocular indirect ophthalmoscope (BIO), which is the current gold standard.
Setting And Design:
Prospective, comparative study.
Materials And Methods:
A total of 87 RetCam examinations were performed on 27 premature babies. They were stored in a separate file after deleting the identifying information. At the same visit using the BIO with scleral depression, an experienced vitreoretinal surgeon evaluated the fundus in detail. A masked examiner then evaluated the RetCam photographs for presence or absence of ROP, the stage and zone of the disease and the presence or absence of plus disease. These data were then compared with the BIO findings to determine the sensitivity, specificity and the positive and negative predictive values of the method.
Results:
ROP was detected in 63 of 87 examinations by BIO and in 56 of 87 RetCam examinations. Nine RetCam examinations were false-negative and two were false-positive. Sensitivity of RetCam was 85.71% (54/63) and specificity was 91.66% (22/24). The positive and negative predictive values were 96.43% and 70.97% respectively.
Conclusion:
Nine cases having ROP were missed by the RetCam. All these cases were either in zone 3 or the outer part of zone 2, which later regressed. These were missed mostly because of the restricted mobility of the camera head caused by its size and the barrier caused by the lid speculum arms. No case of threshold ROP was missed. RetCam may replace BIO for screening of ROP.
