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Photorefraction screening in premature infants
1Department of Ophthalmology, University of Maryland, School of Medicine, Baltimore.
Insights
Photorefraction screening is an acceptable method for detecting ophthalmic abnormalities in premature infants, though success rates can be improved in younger infants. This visual screening aids in early detection of potential vision problems.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Medical Screening Technologies
Background:
- Photorefraction is a key screening tool for identifying amblyogenic ophthalmic abnormalities.
- This technique was integrated into the follow-up care of premature infants.
- The study aimed to evaluate photorefraction's utility in high-risk infants.
Purpose of the Study:
- To assess the applicability of photorefraction screening in premature infants.
- To identify potential visual compromises in this at-risk population.
Main Methods:
- 182 premature infants (over 3 months chronological age) underwent screening with a commercial photorefractor.
- Ophthalmic examinations were conducted concurrently with photorefraction.
- Photorefractions were analyzed by masked observers, with cycloplegia used in most cases.
Main Results:
- The study population had a mean birth weight of 1034.5g and gestational age of 28.2 weeks.
- 18% of infants had ophthalmic abnormalities; screening sensitivity was 77% and specificity 90%.
- Analyzable photorefractions were obtained in 77% of infants, with younger infants (under 3 months corrected age) posing challenges.
Conclusions:
- Photorefraction screening is a viable method for detecting ophthalmic issues in premature infants.
- Improvements in fixation devices may enhance screening success rates in very young infants.
- Further research is needed to optimize photorefraction techniques for this population.
Background:
Photorefraction is a screening technique capable of detecting potentially amblyogenic ophthalmic abnormalities. This screening technique was included as part of a longitudinal outpatient follow-up program of premature infants. The purpose of this investigation is to test the applicability of this screening method in a population of infants at risk for visual compromise.
Methods:
One-hundred eighty-two premature infants older than 3 months chronologic age were screened using a commercially available, off-axis photorefraction device. Ophthalmic examinations were performed concomitant with each photorefraction. In most cases, photorefractions were performed before and after administration of cycloplegic medications. All photorefractions were analyzed by an observer masked to the results of the ophthalmic examination.
Results:
For the 182 patients, the mean birth weight and mean gestational age were 1034.5 g and 28.2 weeks, respectively. The prevalence of ophthalmic abnormalities in the study population was 18%. Sensitivity and specificity rates for the overall screening were 77% and 90%, respectively. Photorefractions were analyzable in 77% of patients studied, with the remaining 23% of our study population unsuccessfully screened. Very young infants (younger than 3 months corrected age) were particularly difficult to photograph, as evidenced by the preponderance of these patients (85%) in the nonanalyzable group. The readability of photorefractions in black infants was improved when cycloplegia was used for the photorefraction.
Conclusion:
Photorefraction screening was an acceptable method of screening for ophthalmic abnormalities in a group of premature infants. Future studies of photorefraction screening techniques in premature infants will need to improve the success rate in young infants, perhaps by improving the fixation device.