Related Experiment Video
Updated: Jan 16, 2026
Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
Published on: March 24, 2020
Comparing infant pain and stress during retinopathy of prematurity screening using ophthalmoscopy and non-contact
Urjita Das1, Euna Cho1, Tara Balasubramanian2
1University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA.
Insights
Laser speckle contrast imaging (LSCI) causes less pain and stress in preterm infants during retinopathy of prematurity (ROP) screening than the standard binocular indirect ophthalmoscopy (BIO) exam, with more stable vital signs.
Area of Science:
- Ophthalmology
- Neonatology
- Medical Technology
Background:
- Retinopathy of prematurity (ROP) screening requires eye examinations in preterm infants.
- Current standard, binocular indirect ophthalmoscopy (BIO), causes significant infant discomfort and stress.
- Objective pain and vital sign assessment is needed to compare examination methods.
Purpose of the Study:
- To compare pain scores and vital sign stability during ROP screening using BIO versus non-contact laser speckle contrast imaging (LSCI).
Main Methods:
- Seventy-one preterm neonates (gestational age 22-32 weeks) underwent ROP screening.
- Infant stress was assessed using the Neonatal Pain, Agitation, and Sedation Scale (N-PASS).
- Vital signs (heart rate, oxygen saturation) were monitored before, during, and after examinations with BIO and LSCI.
Main Results:
- N-PASS scores were significantly lower during LSCI (3.7) compared to BIO (8.8) (p < 0.0001).
- Maximum heart rate was higher during BIO (182 bpm) vs. LSCI (175 bpm) (p = 0.008).
- Minimum oxygen saturation was lower during BIO (83%) vs. LSCI (86%) (p = 0.035), with prolonged vital sign instability after BIO.
Conclusions:
- LSCI is a less painful and stressful alternative to BIO for ROP screening in preterm infants.
- LSCI promotes greater vital sign stability during neonatal eye examinations.
- This non-contact imaging may improve the screening experience for vulnerable neonates.
Abstract:
The current standard of care for retinopathy of prematurity (ROP) screening eye examinations, binocular indirect ophthalmoscopy (BIO), is associated with discomfort and stress in infants. In this study, we compared pain scores and vital signs during examination with BIO and non-contact laser speckle contrast imaging (LSCI). Preterm neonates underwent retinal exam with BIO and LSCI during ROP screening. Infant stress was scored using the Neonatal Pain, Agitation, and Sedation Scale (N-PASS), and collected with vital signs, before, during, and after eye examination. Seventy-one infants with gestational ages 22-32 weeks and birthweights 400-1900 g underwent 196 BIO examinations and 101 LSCI examinations. N-PASS scores during BIO were significantly higher than LSCI (8.8 vs. 3.7, p < 0.0001). Maximum heart rate was significantly higher during BIO compared to LSCI (182 ± 19 beats per minute vs. 175 ± 20 beats per minute, p = 0.008). Minimum oxygen saturation was significantly lower during BIO compared to LSCI (83 ± 12% vs. 86 ± 10%, p = 0.035). After BIO, vital sign instability remained for 30 s, whereas vital signs returned to baseline after LSCI. We found lower pain scores and more stable vital signs during LSCI compared to BIO.
