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Prevalence of sight-threatening ocular abnormalities identified by retinal examination in neonates: a systematic
Rajendra Prasad Anne1, Sheila Samanta Mathai2, Shailaja S3
1Dept. of Neonatology, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India. rajendra.anne@manipal.edu.
Insights
Newborn retinal examination detects sight-threatening eye disorders in 6.1 per 10,000 neonates. This systematic review highlights the effectiveness of retinal screening for early detection and intervention in newborns.
Area of Science:
- Ophthalmology
- Neonatal Care
- Public Health
Background:
- Red reflex testing is limited in detecting treatable newborn eye conditions.
- A systematic review and meta-analysis were conducted to assess newborn retinal examination effectiveness.
- The study focused on identifying treatable sight-threatening abnormalities in neonates.
Purpose of the Study:
- To evaluate the prevalence of sight-threatening disorders detected by newborn retinal examination.
- To compare the efficacy of retinal examination with traditional red reflex testing.
- To inform guidelines for neonatal eye screening protocols.
Main Methods:
- Systematic review and meta-analysis of 13 observational studies (250,513 neonates).
- Searched PubMed, Embase, Web of Science, and Scopus for studies on newborn retinal examination.
- Utilized wide-field retinal imaging (RetCam) and other methods; assessed study quality using JBI tool.
Main Results:
- Prevalence of treatable sight-threatening abnormalities was 6.1 per 10,000 neonates.
- Prevalence of treatable potentially sight-threatening abnormalities was 42.2 per 10,000 neonates.
- Studies were from diverse global locations, with most using wide-field retinal imaging.
Conclusions:
- Newborn retinal examination is effective in detecting multiple sight-threatening abnormalities.
- Early detection through retinal examination allows for timely intervention.
- This screening method offers a significant improvement over traditional red reflex testing.
Background:
Red reflex testing for newborn screening detects only a fifth of disorders requiring intervention. In this systematic review and meta-analysis, we assessed the prevalence of sight-threatening disorders detected by screening newborn babies with retinal examination.
Methods:
We searched PubMed, Embase, Web of Science and Scopus databases for studies assessing newborn retinal examination and reporting treatable sight-threatening abnormalities (cataract, glaucoma and retinoblastoma) and treatable potentially sight-threatening abnormalities (retinitis, vitreous hemorrhage, ROP-like retinopathy and familial exudative vitreoretinopathy). We excluded studies on preterm neonates reporting only ROP and on term neonates reporting only retinal hemorrhages. We adhered to MOOSE guidelines and used the JBI tool for quality assessment and R software for analysis (double arcsine transformation model).
Results:
Thirteen observational studies (250,513 neonates) published between 2015 and 2024 were included in the meta-analysis. The studies were from China, India, Brazil, Malaysia, Indonesia, Turkey and New Zealand. Eleven studies used wide-field retinal imaging by RetCam and its variants, and one study each used indirect ophthalmoscopy and smartphone-based fundus imaging devices. On quality assessment, five studies were at increased risk of bias due to small sample size and/or not including consecutive births. The prevalence of treatable sight-threatening abnormalities was 6.1 per 10,000 neonates (13 studies, 250,513 neonates, 95% CI: 1, 14.1), and the prevalence of treatable potentially sight-threatening abnormalities was 42.2 per 10,000 neonates (12 studies, 250,167 neonates, 95% CI: 19.8, 71.9). No adverse effects were reported.
Conclusions:
Eye screening of neonates with retinal examination can detect several sight-threatening abnormalities amenable to intervention.
Trial Registration:
PROSPERO database with registration number CRD42023448129.
