RT Journal Article
T1 Assessment of non-expert ophthalmologists in the analysis of retinopathy of prematurity
T2 Evaluación de oftalmólogos no expertos en el cribado de la retinopatía del prematuro
A1 Navarro Blanco, Carolina
A1 Pastora Salvador, Natalia
A1 Sánchez Ramos, Celia
A1 Peralta Calvo, Jesús
AB Retinopathy of prematurity (ROP) is currently one of the leading causes of potentially preventable blindness in children. While not every infant that develops ROP of any degree experiences severe disease or requires treatment, early detection is critical to achieve the best possible vision outcomes. However, every day, neonatology and technological advances improve the care and survival of increasingly premature infants, thereby increasing the number of newborn infants at risk of developing ROP.A concern in Europe when it comes to ROP screening, and in Spain in particular, is that not every hospital that offers neonatal care has ophthalmologists on staff that specialise in the care of premature infants. Moral Pumarega et al. analysed ROP screening in neonatal units in a total of 99 public and private hospitals that managed neonates with birth weights under 1500 g. They found that only 39% of surveyed hospitals had specialised paediatric ophthalmologists, while in all other centres evaluations may be performed by any of the ophthalmologists on staff.But what happens when a seasoned ophthalmologist that is not an expert in ROP performs the screening? The examination of the peripheral retina requires specific training and experience, and the procedure has systemic effects on the premature infant.4, 5 We conducted a pilot study to assess the role of the different specialities in clinical ophthalmology in the detection of ROP and referral to a specialist, for which clinicians were asked to analyse retinal images with and without signs of ROP. First, we ought to highlight that intraobserver agreement was excellent in all clinicians, with values ranging from 82% to 98%.The specificity of screening was high for all clinicians (83%–100%), but the sensitivity varied substantially between observers (49%–88%), as only the 2 general ophthalmologists and the expert in ROP exhibited a high sensitivity in the detection of ROP (Table 2). When it came to the referral to a specialist, the results differed substantially between observers and in relation to the results obtained in the other variable. Only the ophthalmologist that was an expert in ROP had acceptable results in both variables (diagnosis of ROP and referral to a specialist). Analysing each clinician individually, we found that the results of a renowned retina specialist of the Community of Madrid (Dr. 2) were poorer than even those of a beginner retina specialist (Dr. 6).The definition of retinography equipment is likely to increase over time, which will probably result in an improvement in the treatment of ROP through telemedicine. Recent studies have analysed artificial intelligence as a diagnostic method, an additional step in the objective assessment of retinopathy that does not require an expert in ROP.6 Still, further research is required in this emerging field. Timing is crucial in ROP screening, and telemedicine helps overcome many of the limitations of the conventional approach to diagnosis. This approach could allow excellence in care in the assessment and management of infants with ROP.In this day and age, allowing the occurrence of totally preventable cases of blindness is completely unacceptable. First, on account of affected children and their families, and, if this were not enough reason, due to the economic cost for the state of a visually impaired individual. On the other hand, we need to consider the legal repercussions that may be faced by ophthalmologists. Thus, we should prioritise training of ROP specialists able to provide rigorous care and follow-up.In conclusion, our pilot study evinced substantial variability in the assessment of ROP by experienced ophthalmologists, independently of the years of experience or the subspeciality of ophthalmology, and that the diagnosis and treatment of ROP require specific training. Retinopathy of prematurity and its sequelae can cause problems throughout the lifespan, so correct assessment is crucial to reduce the potentially devastating impact of this disease, which is surging in countries with different incomes and levels of development. Therefore, until effective artificial intelligence models are developed, we need to ensure the availability of ophthalmologists specialised in ROP who can make an accurate diagnosis through telemedicine.
AB Actualmente, la retinopatía del prematuro (ROP) es una de las principales causas de ceguera infantil potencialmente evitable. Es importante destacar que no todos los casos de recién nacidos que desarrollan algún grado de ROP son graves o requieren tratamiento, la detección precoz es crítica para lograr el mejor resultado visual. Sin embargo, día a día la neonatología avanza, la tecnología mejora el cuidado y aumenta la supervivencia de niños cada vez más prematuros, lo que incrementa el número de recién nacidos con riesgo de padecer ROP.Un hecho preocupante en Europa, y en el caso español en particular, acerca del cribado de la ROP es que no todos los hospitales con servicios de neonatología disponen de oftalmólogos especializados en prematuros. Moral Pumarega et al. analizan el cribado de la ROP en unidades neonatales, un total de 99 hospitales públicos y privados que atienden a recién nacidos con un peso inferior a 1.500 g. En su estudio, publicaron que solo el 39% de los centros encuestados dispone de oftalmólogos especializados en enfermedades pediátricas, mientras que en el resto de los hospitales puede ser cualquier oftalmólogo de la plantilla el que realice la exploración.Pero ¿qué ocurre cuando un oftalmólogo consolidado sin experiencia en ROP hace el reconocimiento? La exploración de la retina periférica del recién nacido requiere entrenamiento y experiencia, y es un procedimiento con efectos sistémicos sobre el prematuro4, 5. En este estudio piloto se evalúa el papel de las diferentes áreas en oftalmología clínica a la hora de detectar y remitir la enfermedad; para ello se analizan retinografías con y sin signos de ROP. En primer lugar, hay que destacar que la concordancia intraobservacional de cada evaluador es excelente, obteniendo valores entre el 82 y el 98%
PB Elsevier
SN 2341-2879 (english edition)
SN 1695-4033 (edición en español)
YR 2022
FD 2022-02-01
LK https://hdl.handle.net/20.500.14352/105413
UL https://hdl.handle.net/20.500.14352/105413
LA eng
NO Navarro-Blanco C, Pastora-Salvador N, Sánchez-Ramos C, Peralta-Calvo J. Assessment of non-expert ophthalmologists in the analysis of retinopathy of prematurity. An Pediatr (Engl Ed). 2022;96(2):147-148. doi:10.1016/j.anpede.2020.10.015
NO Available online 1 February 2022, Version of Record 2 March 2022.
DS Docta Complutense
RD 21 abr 2025