Neonatal eye screening for 203 healthy term newborns using a wide-field digital retinal imaging system

Abstract Purpose This study aimed to determine the proportion and types of ocular abnormalities detected in healthy term newborns and also the risk factors associated with retinal haemorrhages. Method This cross-sectional study comprised of 203 participants, all healthy term newborn infants in the Obstetrics and Gynaecology ward at Hospital Kuala Lumpur over a six months period. The examination list includes external eye examination, red reflex test, and fundus imaging using a wide-field digital retinal imaging system (Phoenix Clinical ICON Paediatric Retinal Camera) by a trained Investigator. The pathologies detected were documented. The results were compared with similar studies previously published in the literature. Results Total ocular abnormalities were detected in 34% infants. The most common finding was retinal haemorrhage in 29.6% infants, of which 53.3% occurred bilaterally. Spontaneous vaginal delivery (SVD) remained the greatest risk factor which has nearly four times higher risk of newborns developing retinal haemorrhage compared to Lower Segment Caesarean Section (LSCS). There was a 6% increased likelihood of developing retinal haemorrhage for every 1 minute increment in the duration of 2nd stage of labour. Newborns delivered via SVD with episiotomy had 2.5 higher odds of developing retinal haemorrhage in newborns compared to SVD without episiotomy. Conclusion Universal eye screening for all newborns using a wide-field digital imaging system is possible, safe and useful in detecting posterior segment disorders. The most common abnormality detected is retinal haemorrhage. Although most resolve spontaneously, a longitudinal study is needed to study the long term effect of retinal haemorrhages in these infants.

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Neonatal eye screening for 203 healthy term new-borns using a wide-field digital retinal imaging system

BMC Ophthalmology ◽

10.1186/s12886-021-01882-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kenneth Teow Kheng Leong ◽

Siti Nur Amira Abu Kassim ◽

Jasvinjeet Kaur Sidhu ◽

Zayani Zohari ◽

Thivakar Sivalingam ◽

...

Keyword(s):

Imaging System ◽

Retinal Imaging ◽

Common Finding ◽

Wide Field ◽

Retinal Haemorrhage ◽

Cross Sectional ◽

Ocular Abnormalities ◽

New Born ◽

Eye Screening ◽

Eye Examination

Abstract Background The current practice for new-born eye examination by an Ophthalmologist in Malaysian hospitals is limited to only preterm new-borns, syndromic or ill infants. Healthy term new-borns are usually discharged without a thorough eye examination. This study is aimed at determining the proportion and types of ocular abnormalities detected in purportedly healthy term new-borns. Method This cross-sectional study is comprised of 203 participants, all purportedly healthy term new-born infants from the Obstetrics and Gynaecology ward at Hospital Kuala Lumpur over a 6 months period. The examination list includes external eye examination, red reflex test, and fundus imaging using a wide-field digital retinal imaging system (Phoenix Clinical ICON Paediatric Retinal Camera) by a trained Investigator. The pathologies detected were documented. The results were compared and correlated with similar studies published in the literature previously. Results Total ocular abnormalities were detected in 34% of the infants. The most common finding was retinal haemorrhage in 29.6% of the infants, of which 53.3% occurred bilaterally. Spontaneous vaginal delivery (SVD) remained the greatest risk factor which has nearly 3.5 times higher risk of new-borns developing retinal haemorrhage compared to Lower Segment Caesarean Section (LSCS). There was a 6% increased likelihood of developing retinal haemorrhage for every 1-min increment in the duration of 2nd stage of labour. Conclusion Universal eye screening for all new-borns using a wide-field digital imaging system is realistically possible, safe, and useful in detecting posterior segment disorders. The most common abnormality detected is retinal haemorrhage.

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Neonatal Eye Screening for 203 Healthy Term Newborns Using a Wide-Field Digital Retinal Imaging System

10.21203/rs.2.16561/v2 ◽

2020 ◽

Author(s):

Kenneth Teow Kheng Leong ◽

Siti Nur Amira Abu Kassim ◽

Jasvinjeet Kaur Sidhu ◽

Zayani Zohari ◽

Thivakar Sivalingam ◽

...

Keyword(s):

Imaging System ◽

Newborn Infants ◽

Cross Sectional Study ◽

Common Finding ◽

Wide Field ◽

Retinal Haemorrhage ◽

Cross Sectional ◽

Ocular Abnormalities ◽

Lower Segment Caesarean Section ◽

Retinal Haemorrhages

Abstract Purpose: This study aimed to determine the proportion and types of ocular abnormalities detected in healthy term newborns and also the risk factors associated with retinal haemorrhages.Method: This cross-sectional study comprised of 203 participants, all healthy term newborn infants in the Obstetrics and Gynaecology ward at Hospital Kuala Lumpur over a six months period. The examination list includes external eye examination, red reflex test, and fundus imaging using a wide-field digital retinal imaging system (Phoenix Clinical ICON Paediatric Retinal Camera) by a trained Investigator. The pathologies detected were documented. The results were compared with similar studies previously published in the literature.Results: Total ocular abnormalities were detected in 34% infants. The most common finding was retinal haemorrhage in 29.6% infants, of which 53.3% occurred bilaterally. Spontaneous vaginal delivery (SVD) remained the greatest risk factor which has nearly 3.5 times higher risk of newborns developing retinal haemorrhage compared to Lower Segment Caesarean Section (LSCS). There was a 6% increased likelihood of developing retinal haemorrhage for every 1 minute increment in the duration of 2nd stage of labour. Conclusion: Universal eye screening for all newborns using a wide-field digital imaging system is possible, safe and useful in detecting posterior segment disorders. The most common abnormality detected is retinal haemorrhage. Although most resolve spontaneously, a longitudinal study is needed to study the long term effect of retinal haemorrhages in these infants.

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Fundus examination of 199 851 newborns by digital imaging in China: a multicentre cross-sectional study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312366 ◽

2018 ◽

Vol 102 (12) ◽

pp. 1742-1746 ◽

Cited By ~ 2

Author(s):

He Tang ◽

Na Li ◽

Zhan Li ◽

Meiju Zhang ◽

Meirong Wei ◽

...

Keyword(s):

Digital Imaging ◽

Large Scale ◽

Imaging System ◽

Cross Sectional Study ◽

Wide Field ◽

Fundus Examination ◽

Sectional Study ◽

Cross Sectional ◽

Ocular Abnormalities ◽

Ocular Health

BackgroundThe prevalence of ocular abnormalities of newborn in China has seldom been reported. To report the implementation of digital imaging in ocular screening of all newborns in multiple centres in China and to describe the abnormal findings of fundus examination, we did the cross-sectional study.MethodsFundus examinations were performed on newborns within the 42 days after birth using a RetCam wide-field digital imaging system. Digital images of the posterior pole, superior, nasal and temporal retinal fields of each participant were taken. All newborns were from eights centres across China from January 2009 to July 2017.ResultsA total of 199 851 newborns were included in the study. We detected 18 198 (9.11%) abnormal cases. The most frequent abnormality was severe retinal haemorrhage (RH) found in 12 810 cases (6.41%). The other anomalies included familial exudative vitreoretinopathy, retinopathy of prematurity, abnormal fundus pigmentation, subconjunctival haemorrhage, choroidal coloboma, idiopathic retinal venous tortuosity, exudative changes and other anomalies with uncertain identities.ConclusionThis large-scale study of newborn fundus examination showed a relatively high prevalence of ocular abnormalities. Hundreds of neonates with rare disorders that severely impair ocular health were also detected at an early age. The long-term impact of other anomalies including RHs on the ocular system should be investigated by a perspective study. Our study suggested that fundus examination of newborns can play a beneficial role in ocular health.

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Prospective observational study of universal newborn eye screening in a hospital and community setting in New Zealand

BMJ Paediatrics Open ◽

10.1136/bmjpo-2018-000376 ◽

2019 ◽

Vol 3 (1) ◽

pp. bmjpo-2018-000376 ◽

Cited By ~ 3

Author(s):

Samantha Kaye Simkin ◽

Stuti L Misra ◽

Malcolm Battin ◽

Charles N J McGhee ◽

Shuan Dai

Keyword(s):

New Zealand ◽

Optic Nerve ◽

Congenital Cataract ◽

Newborn Infants ◽

Community Setting ◽

Optic Nerve Hypoplasia ◽

Wide Field ◽

Ocular Abnormalities ◽

Eye Screening ◽

Retinal Haemorrhages

ObjectiveEarly detection of ocular abnormalities in newborn infants is essential for timely diagnosis and treatment. This study aimed to assess wide-field digital imaging for universal newborn eye screening (UNES) to determine the prevalence of ocular abnormalities, including retinal haemorrhages, in newborn infants in New Zealand.DesignProspective ocular screening study of infants.SettingA public hospital maternity ward and a community birth centre in Auckland, New Zealand.PatientsA total of 350 infants were enrolled in UNES, those with birth weight <1250 g or gestational age <30 weeks were excluded.MethodsWide-field digital images of the external eye and retina were captured by RetCam (Natus Medical, San Carlos, California, USA) and reviewed by an ophthalmologist via an established telemedicine methodology.Main outcome measuresDetection of ocular abnormalities, including retinal haemorrhages. Correlation between haemorrhages and maternal, obstetric and neonatal factors.ResultsA total of 346 infants completed screening (median age 2 days). Retinal haemorrhages were present in 50 cases (14.5%), two cases exhibited persistent retinal haemorrhages at 6-week follow-up. A significant increase in the odds of retinal haemorrhages was present for vaginal delivery compared with caesarean section. Other ocular abnormalities, including congenital cataract and optic nerve hypoplasia, were present in 1.4% of infants.ConclusionsOcular abnormalities were detected by UNES including congenital cataract and optic nerve hypoplasia. However, retinal haemorrhages, significantly associated with delivery modality, were the most common abnormality detected. The majority of retinal haemorrhages resolved spontaneously.

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Retinal abnormalities in universal eye screening of healthy, full-term newborn infants in Jakarta. The incidence and its risk factors: a pilot study

International Journal of Retina and Vitreous ◽

10.1186/s40942-021-00337-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Rita S. Sitorus ◽

Indra Maharddhika Pambudy ◽

Rinawati Rohsiswatmo ◽

Julie Dewi Barliana ◽

Dian Estu Yulia ◽

...

Keyword(s):

Risk Factors ◽

Newborn Infants ◽

Retinal Hemorrhage ◽

Full Term ◽

Common Finding ◽

Wide Field ◽

Ocular Abnormalities ◽

Term Newborn ◽

Eye Screening ◽

Ocular Abnormality

Abstract Aim To screen for ocular abnormalities in healthy full-term newborn infants using wide-field digital imaging and to analyze factors associated with the findings. Methods A total of 1208 full-term newborn infants at a tertiary eye hospital (Cipto Mangunkusumo National Referral Hospital) and a district hospital in Jakarta (Koja Hospital) were enrolled to the study. All eligible newborns underwent fundus examination within 48 h after birth using the RetCam shuttle (Natus Medical Incorporated, USA). Retinal findings were documented and analyzed according to obstetric and neonatal risk factors. Results Of the 1208 newborn infants enrolled, ocular abnormalities were found in 150 infants (12.4%). Retinal hemorrhage (RH) was the most common finding (88%) in which 2.67% involved the macula, followed by chorioretinitis (4.67%). Univariate analysis showed caesarean section (C-section) (OR 0.27, 95% CI 0.18–0.41, p < 0.001) was a protective factor against RH, while prolonged labor increased the risk of developing RH (OR 1.84, 95% CI 1.24–2.72, p = 0.002). Further multivariate analysis showed similar protective association between C-section and risk of RH (OR 0.29, 95% CI 0.19–0.44, p < 0.001), while other risk factors were not. Conclusions Our study showed that universal eye screening in healthy neonates is beneficial in the early diagnosis, monitoring and treatment of ocular abnormalities such as retinal hemorrhage, chorioretinitis and retinoblastoma. Retinal hemorrhage is the most common ocular abnormality and is associated with the delivery method and the duration of labor. Universal eye screening is visual-saving and life-saving for neonates with chorioretinitis, retinoblastoma as well as other abnormalities and should be mandatory in newborn screening.

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Findings of Eye Screening Examinations with Wide-Field Digital Imaging System in Healthy Newborns

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2015.56.10.1617 ◽

2015 ◽

Vol 56 (10) ◽

pp. 1617 ◽

Cited By ~ 1

Author(s):

Se Young Park ◽

So Young Kim

Keyword(s):

Digital Imaging ◽

Imaging System ◽

Wide Field ◽

Eye Screening ◽

Digital Imaging System

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The retinal lesions in ultra-wide-field retinal imaging and the consistency of different fundus screening methods in HIV/AIDS patients

10.21203/rs.2.16051/v1 ◽

2019 ◽

Author(s):

Kuifang Du ◽

Chao Chen ◽

Chungang Guo ◽

Hongwei Dong ◽

Lian-yong Xie ◽

...

Keyword(s):

Detection Rate ◽

Imaging System ◽

Retinal Imaging ◽

Screening Methods ◽

Wide Field ◽

Slit Lamp ◽

Aids Patients ◽

Retinal Lesions ◽

Fundus Imaging ◽

Hiv Aids

Abstract Background: To observe the retinal lesions in HIV/AIDS patients and to evaluate the consistency of non-mydriatic ultra-wide-field (UWF) retinal imaging and mydriatic slit lamp biomicroscope with Superfield lens. Methods: 193 eyes of 98 consecutive HIV/AIDS patients were enrolled. The retinal lesions in each patients were observed through UWF fundus imaging and slit lamp biomicroscopic with Superfield lens whose consistency was analyzed. Results: 100 eyes (51.8%） had fundus lesions, 20 eyes (20%) presented posterior microvascular retinopathy (MVR), 19 eyes (19%) presented peripheral MVR, 15 eyes (15%) presented early stage cytomegalovirus retinitis (CMVR), 6 eyes showed initial stage CMVR, and 51 eyes showed other changes (papilledema, etc.). The consistency of two methods was moderate in detecting the isolated peripheral lesions (Kappa = 0.445) or HIV-related MVR (Kappa = 0.513), and high in inspecting the posterior/posterior involved lesions (Kappa = 0.831) or CMVR (Kappa = 1.0). The detection rate of UWF retinal imaging and slit lamp biomicroscopic were 15.5%（30/193）and 17.6%（34/193）(P=0.557＞0.05) for HIV-related MVR, 7.8% (15/193) (P=1.000＞0.05) for CMVR, 37.3% (72/193) and 33.7% (65/193) (P=0.118＞0.05) for posterior/posterior involved lesions, 8.8% (17/193) and 17.6% (34/193) (P=0.001＜0.05) for isolated peripheral lesions , respectively. Conclusions: The HIV-related MVR can be posterior or peripheral. Various fundus changes appear in HIV/AIDS patients, not only MVR or CMVR. The non-mydriatic UWF fundus imaging system and mydriatic slit lamp biomicroscope exhibited good consistency and nondiscriminatory detection rate for CMVR, HIV-related MVR and posterior lesions, but not for isolated peripheral lesions.

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Observation of the far peripheral retina of normal eyes by ultra-wide field fluorescein angiography

European Journal of Ophthalmology ◽

10.1177/1120672120926453 ◽

2020 ◽

pp. 112067212092645

Author(s):

Xiaoling Wang ◽

A’min Xu ◽

Zuohuizi Yi ◽

Lu He ◽

Juejun Liu ◽

...

Keyword(s):

Fluorescein Angiography ◽

Imaging System ◽

Late Phase ◽

Clinical Work ◽

Cross Sectional Study ◽

Peripheral Retina ◽

Wide Field ◽

Cross Sectional ◽

Avascular Area ◽

Visual Disturbances

Purpose The appearance of the far peripheral retina in normal eyes was observed using an Optos ultra-wide field fluorescein angiography imaging system. Methods A cross-sectional study of ultra-wide field pseudocolor and angiography images obtained using the Optos 200Tx. Four different non-vascular and six vascular-associated fluorescence features in far peripheral retina were analyzed. Results A total of 166 eyes in 83 patients met the inclusion criteria. The mean patient age was 40.78 ± 10.94 years (range: 20–65 years) with a female-to-male ratio of 0.98. Slight cataract were present in 64 eyes (38.55%), low to moderate myopia in 50 eyes (30.12%), and unspecified visual disturbances in 52 eyes (31.33%). Far peripheral retinas were found to have mottled florescent band in 42.17% eyes, ground glass hyperfluorescence in 84.34% eyes, granular hyperfluorescence in 12.65% eyes, local mottled fluorescence in 10.84% eyes, vascular anastomosis with a peripheral avascular area in 36.23% eyes, invisible capillary details in 50.67% eyes, vessels passing through the ora serrata in 16.98% eyes, late-phase slight leakage in 32.53% eyes, angiectasis in 18.67% eyes, and microaneurysm in 34.94% eyes. Conclusion Ultra-wide field fluorescein angiography revealed various fluorescence features in the periphery of normal eyes, providing a basis for interpreting normal and pathological changes in peripheral retina and an important reference for clinical work.

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Ocular findings in Universal Eye Screening of healthy, full-term newborn infant in Jakarta. The incidence and its risk factors: an observational study

10.21203/rs.2.10617/v1 ◽

2019 ◽

Author(s):

Rita S Sitorus ◽

Indra Maharddhika Pambudy ◽

Rinawati Rohsiswatmo ◽

Julie Dewi Barliana ◽

Dian Estu Yulia ◽

...

Keyword(s):

Risk Factors ◽

Univariate Analysis ◽

Newborn Infants ◽

Retinal Hemorrhage ◽

Full Term ◽

Wide Field ◽

Ocular Abnormalities ◽

Term Newborn ◽

Eye Screening ◽

Ocular Abnormality

Abstract Background To document ocular abnormalities in healthy full-term newborn infants using wide-field digital imaging and to analyze factors associated with the findings. Methods A total of 1208 full-term newborn infants at a tertiary eye hospital (Cipto Mangunkusumo National Referral Hospital) and a district hospital in Jakarta (Koja Hospital) were enrolled to the study. All eligible newborns underwent fundus examination within 48 hours after birth using the RetCam shuttle (Natus Medical Incorporated, USA). All eye findings were documented and analyzed according to obstetric and neonatal risk factors. Results Of the 1208 newborn infants enrolled, ocular abnormalities were found in 150 infants (12.4%). Retinal hemorrhage (RH) was the most common findings (88%) in which 2.67% involved the macula, followed with chorioretinitis (4.67%). Univariate analysis showed caesarean section (C-section) (OR 0.27, 95% CI 0.18-0.41, p<0.001) as the protective factor towards RH, while prolonged labor increased the risk of developing RH (OR 1.84, 95% CI 1.24-2.72, p=0.002). Further multivariate analysis showed similar protective association between C-section and risk of RH (OR 0.29, 95% CI 0.19-0.44, p<0.001), while other risk factors were not. Conclusions Our study supports previous reports that universal eye screening is an essential procedure which may detect several important ocular abnormalities. Retinal hemorrhage is the most common ocular abnormality and is associated with the methods of delivery and duration of labor. As the ocular abnormalities may go unnoticed during standard practice, a universal eye screening program could be considered as an essential part of newborn screening especially amongst those with prolonged labors.

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