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Published on: March 17, 2023
Universal ocular screening of 1021 term infants using wide-field digital imaging in a single public hospital in India
Anand Vinekar1, Indu Govindaraj1, Chaitra Jayadev1
1Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India.
Insights
Wide-field digital imaging can safely screen all newborns for eye abnormalities. This pilot study suggests universal infant eye screening is feasible and could prevent thousands of undiagnosed conditions annually.
Area of Science:
- Ophthalmology
- Neonatal Care
- Medical Imaging
Background:
- Universal eye screening for neonates is not standard practice.
- Early detection of neonatal eye abnormalities can reduce visual morbidity.
- Wide-field digital imaging offers a potential tool for universal screening.
Purpose of the Study:
- To assess the feasibility of using wide-field digital imaging for universal neonatal eye screening.
- To identify potential abnormalities in newborns through early detection.
Main Methods:
- A pilot study enrolled 1021 term infants within 72 hours of birth.
- Retcam shuttle imaging captured anterior and posterior segment views.
- Infants with abnormal findings received clinical examination and necessary treatment.
Main Results:
- 4.7% of newborns (48/1021) had abnormal eye findings.
- Retinal hemorrhages were most common (52.1%), including macular involvement.
- Nine infants (0.9%) required medical or surgical intervention for conditions like cataract and retinoblastoma.
Conclusions:
- Universal neonatal eye screening via wide-field digital imaging is feasible and safe.
- An estimated 226,950 infants nationally could go undiagnosed annually without universal screening.
- National consideration of universal infant eye imaging strategies is recommended.
Purpose:
Universal eye screening of neonates is currently not standard of care. Early detection of abnormalities could offer prompt management and a reduction in visual morbidity. We report a pilot study using wide-field digital imaging to screen all infants at birth to explore its feasibility as a tool for universal screening.
Methods:
Consecutively enrolled 1021 term infants in a public hospital were imaged within 72 hr of birth using the Retcam shuttle (Clarity MSI, USA). Anterior and dilated posterior segment images were obtained. Infants with abnormal images were examined clinically, and medical or surgical treatment was given when needed, at no cost to the family.
Results:
Of the 1021 healthy full-term newborns, 48 babies had abnormal findings (4.7%). Retinal haemorrhages were the most common (52.1%) abnormality of which 24% were macular. A 'ridge' resembling retinopathy of prematurity in both eyes constituted 18.8% of all abnormalities. Nine infants (18.8% of abnormalities and 0.9% overall) had conditions meriting medical or surgical intervention and would have been missed otherwise. Seven of these nine babies (0.7%) needed medical attention with a systemic work-up for conditions such as posterior uveitis with linear perivasculitis, salt and pepper retinopathy or posterior synechia. Two of nine babies (0.2%) required surgical intervention for unilateral cataract and retinoblastoma.
Conclusion:
Universal eye screening of all neonates using wide-field digital imaging is possible and safe. Extrapolating our results to the national scenario, we estimate that 226 950 infants requiring treatment would go undiagnosed annually. Universal infant eye imaging strategies must receive serious national consideration.
