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Specialist Nurse Screening for Retinopathy of Prematurity-A Pilot Study
Shaheen P Shah1, Zhen Wu, Sharron Iverson
1From the *Department of Ophthalmology, Auckland, New Zealand, Auckland; and †International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
Purpose:
To compare the accuracy of retinopathy of prematurity (ROP) screening between nurse specialists and an expert pediatric ophthalmologist.
Design:
A comparative case series of ROP screening in a level 2 neonatal intensive care unit setting where there is a higher threshold for accepting very premature or unwell neonates.
Methods:
Trained specialist ROP nurses acquired wide-field digital images, graded ROP, and proposed a follow-up plan. This was compared with the findings by an ROP expert ophthalmologist. Outcomes include sensitivity, specificity, positive predictive value, and negative predictive value of ROP grading by trained ROP nurses.
Results:
Mean gestational age was 28.6 weeks, and mean birth weight was 1184 g of the 64 consecutive neonates included. A total 316 eye screens was performed. Image acquisition, grading, and a management plan by the ROP nurse were possible in all screens. In right eyes, the presence of any ROP (stage >0) was 15%. Sensitivity, specificity, positive predictive value, and negative predictive value of ROP grading were 91.7% (95% CI, 73%-99%), 80.6% (95% CI, 72.9%-86.9%), 45.8% (95% CI, 31.4%-60.80%), and 98.2% (95% CI, 93.6%-99.8%), respectively. Agreement on the management plan occurred in 84.8% of cases. In virtually all circumstances of disagreement, ROP nurses exaggerated the ROP grading present and/or recommended a repeat screen when discharge from service was more appropriate.
Conclusions:
Our preliminary findings demonstrated good agreement between ROP nurses and the ROP expert ophthalmologist. Further research in expanding the role of utilizing nonphysician health workers in ROP screening is suggested.
