Purpose: To evaluate (1) the feasibility of nonophthalmologist healthcare workers (HCWs) obtaining images of sufficient quality for retinopathy of prematurity (ROP) screening using a Food and Drug Administration-approved portable, noncontact, narrow-field fundus camera (i.e., Pictor; Volk Optical, Inc, Mentor, OH) and (2) the accuracy of grading these images to identify infants in whom treatment-warranted (type 1) ROP developed. Design: Prospective cohort study. Participants: Infants undergoing routine ROP screening examinations (i.e., birth weight ≤1500 g, gestational age ≤30 weeks, or both, or selected infants with a birth weight of 1500–2000 g or gestational age >30 weeks and an unstable clinical course). Methods: We prospectively recruited infants undergoing ROP screening examinations at a community hospital. On the same day an ophthalmologist examined them, a trained HCW imaged their retinas using the noncontact camera. Two masked ROP experts graded these images remotely. We calculated both the percentage of gradable images (i.e., having at least 3 quadrants with sufficient image quality), as well as the accuracy of identifying infants in whom type 1 ROP developed. Main Outcome Measures: Percentage of gradable images and the sensitivity and specificity of each grader for identifying infants with type 1 ROP by grading for the presence of preplus or plus disease. Results: Ninety-nine infants were included. Overall, 92.4% and 94.2% of all infant imaging sessions were considered gradable by graders 1 and 2, respectively. Among gradable images, the sensitivity of both graders for identifying type 1 ROP by grading for the presence of preplus or plus disease was 100% (95% confidence interval [CI], 95%–100%), and the specificity was 91% (95% CI, 83%–95%) for grader 1 and 93% (95% CI, 86%–96%) for grader 2. Conclusions: It was highly feasible for trained HCWs to obtain digital retinal images of sufficient quality for ROP screening using a noncontact fundus camera. By grading for the presence of preplus or plus disease, graders identified infants in whom type 1 ROP developed with high sensitivity and specificity. The use of portable, noncontact retinal cameras by trained HCWs could increase our workforce in ROP screening and identify infants needing indirect ophthalmoscopy examinations by an ophthalmologist.
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