Specialist Nurse Screening for Retinopathy of Prematurity-A Pilot Study.

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.