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Evaluating and optimizing retinal examination methods for diagnosing retinopathy of prematurity in premature infants
Tian Liu1, Daoman Xiang1, Wensi Chen1
1Ophthalmology Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China.
Insights
Binocular Indirect Ophthalmoscope (BIO) and RetCam imaging show high accuracy for diagnosing Retinopathy of Prematurity (ROP). BIO excels in subtle findings, while RetCam offers wide-field documentation, suggesting a combined approach enhances ROP screening.
Area of Science:
- Ophthalmology
- Neonatology
- Medical Imaging
Background:
- Retinopathy of Prematurity (ROP) is a significant cause of vision impairment in preterm infants.
- Accurate and timely diagnosis of ROP is crucial for effective treatment and prevention of visual loss.
- Current diagnostic methods include direct ophthalmoscopy and wide-field imaging, each with potential advantages and limitations.
Purpose of the Study:
- To compare the diagnostic effectiveness of Binocular Indirect Ophthalmoscope (BIO) and Wide-Field Fundus Imaging System (RetCam) for Retinopathy of Prematurity (ROP).
- To evaluate the performance of both modalities in classifying ROP zone, stage, plus/pre-plus disease, and lesion extent.
Main Methods:
- Retrospective review of paired BIO and RetCam3 examinations from 398 preterm infants (796 eyes) screened for ROP.
- Standardized screening workflow with BIO performed by a senior ophthalmologist, followed by RetCam3 imaging.
- Adjudicated reference standard established by consensus review of BIO sketches and RetCam images by three experienced ophthalmologists.
Main Results:
- Both BIO and RetCam demonstrated high Area Under the Curve (AUC) values for ROP detection (0.997 and 0.995, respectively).
- BIO showed superior accuracy in stage classification (0.999 vs. 0.959 for RetCam), while RetCam had lower agreement for lesion extent (p < 0.001).
- RetCam misdiagnoses were more frequent in zone III and stage 1 ROP.
Conclusions:
- BIO and RetCam possess complementary strengths for ROP screening.
- BIO offers superior 3D peripheral assessment of subtle findings, whereas RetCam provides objective wide-field documentation.
- A combined diagnostic strategy integrating BIO and RetCam may enhance diagnostic confidence and clinical management of ROP.
Purpose:
This study aims to evaluate and compare the effectiveness of the Binocular Indirect Ophthalmoscope (BIO) and the Wide-Field Fundus Imaging System (RetCam) in the diagnosis of Retinopathy of Prematurity (ROP).
Methods:
We retrospectively reviewed routinely collected records from a standardized paired-screening workflow for preterm infants examined for ROP in outpatient and inpatient settings during 2020-2021. BIO was performed first by a senior pediatric ophthalmologist, followed within 10 min by RetCam3 imaging by another ophthalmologist. The paired BIO sketches and RetCam images were reviewed by three experienced ophthalmologists, and disagreements were resolved by consensus to establish an adjudicated reference standard for this study. The primary outcome was diagnostic accuracy for ROP zone, stage, plus/pre-plus disease, and lesion extent.
Results:
A total of 796 eyes from 398 preterm infants (birth weight 1323.8 +/- 456.2 g; gestational age 29.8 +/- 2.9 weeks) were examined using both BIO and RetCam. Compared with the adjudicated reference standard, BIO and RetCam achieved AUCs of 0.997 and 0.995 for detecting any ROP, 0.983 and 0.982 for zone classification, and 0.999 and 0.959 for stage classification, respectively. RetCam misdiagnoses were most common in zone III and stage 1 disease. BIO showed lower agreement than RetCam for lesion extent (p < 0.001).
Conclusion:
BIO and RetCam showed complementary strengths in ROP screening. BIO provided clearer peripheral three-dimensional assessment of subtle stage and plus/pre-plus findings, whereas RetCam provided objective wide-field documentation of lesion distribution. A combined strategy may improve diagnostic confidence and clinical management for ROP.
