ABSTRACT
PURPOSE: To evaluate an alternative retinopathy of prematurity (ROP) screening system that identifies infants meriting examination by an ophthalmologist in a middle-income country. METHODS: The authors hypothesized that grading posterior pole images for the presence of pre-plus or plus disease has high sensitivity to identify infants with type 1 ROP that requires treatment. Part 1 of the study evaluated the feasibility of having a non-ophthalmologist health care worker obtain retinal images of prematurely born infants using a non-contact retinal camera (Pictor; Volk Optical, Inc., Mentor, OH) that were of sufficient quality to grade for pre-plus or plus disease. Part 2 investigated the accuracy of grading these images to identify infants with type 1 ROP. The authors prospectively recruited infants at Chulalongkorn University Hospital (Bangkok, Thailand). On days infants underwent routine ROP screening, a trained health care worker imaged their retinas with Pictor. Two ROP experts graded these serial images from a remote location for image gradability and posterior pole disease. RESULTS: Fifty-six infants were included. Overall, 69.4% of infant imaging sessions were gradable. Among gradable images, the sensitivity of both graders for identifying an infant with type 1 ROP by grading for the presence of pre-plus or plus disease was 1.0 (95% confidence interval [CI]: 0.31 to 1.0) for grader 1 and 1.0 (95% CI: 0.40 to 1.0) for grader 2. The specificity was 0.93 (95% CI: 0.76 to 0.99) for grader 1 and 0.74 (95% CI: 0.53 to 0.88) for grader 2. CONCLUSIONS: It was feasible for a trained non-ophthalmologist health care worker to obtain retinal images of infants using the Pictor that were of sufficient quality to identify infants with type 1 ROP. [J Pediatr Ophthalmol Strabismus. 2018;55(4):245-253.].
Subject(s)
Diagnostic Techniques, Ophthalmological , Image Interpretation, Computer-Assisted , Neonatal Screening/methods , Retinopathy of Prematurity/diagnosis , Telemedicine/methods , Gestational Age , Health Personnel , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Photography/instrumentation , Pilot Projects , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , ThailandABSTRACT
PURPOSE: This was a prospective descriptive study to determine the changes in intraocular lens (IOL) position after neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy by measuring anterior chamber depth (ACD) and refraction, including the spherical equivalent (SE) and cylinder. MATERIALS AND METHODS: Forty-seven pseudophakic eyes with posterior capsule opacification of 29 patients were included. Nd:YAG laser posterior capsulotomy was performed. Patients' ACD and refraction were measured before the treatment, as well as after the treatment at 1 week and 3 months. IOLMaster(®) and an automated refractometer were used at the Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. RESULTS: There were no statistically significant differences in ACD and SE before and after laser treatment at 1 week and 3 months (repeated analysis of variance, P=0.582 and P=0.269, respectively). Both backward IOL movement (number [n]=29) and forward IOL movement (n=18) were found. Some changes in cylindrical refraction were found at 1 week, but decreased at 3 months after capsulotomy (baseline cylinder: -1.16; cylinder at 1 week and 3 months: -1.00 and -1.14, respectively; P=0.012). These changes were the same with one-piece and three-piece IOLs. CONCLUSION: Nd:YAG laser posterior capsulotomy did not significantly change ACD and SE. It led to cylinder change at 1 week after laser, but the effect decreased at 3 months. This effect was small and may not be clinically significant.
