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9. Comparison between wide‐field digital imaging system and the red reflex test for universal newborn eye screening in Brazil

Author

Cunha, Laura Pires, primary, Cavalcante Costa, Marcelo Alexandre Agra, additional, Miranda, Homero Augusto, additional, Reis Guimarães, Juliana, additional, Aihara, Teruo, additional, Ludwig, Cassie A., additional, Rosenblatt, Tatiana, additional, Callaway, Natalia F., additional, Pasricha, Malini, additional, Al‐Moujahed, Ahmad, additional, Vail, Daniel, additional, Ji, Marco H., additional, Kumm, Jochen, additional, and Moshfeghi, Darius M., additional

Published
2021
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11. Comparison between wide‐field digital imaging system and the red reflex test for universal newborn eye screening in Brazil.

Author

da Cunha, Laura Pires, Cavalcante Costa, Marcelo Alexandre Agra, de Miranda, Homero Augusto, Reis Guimarães, Juliana, Aihara, Teruo, Ludwig, Cassie A., Rosenblatt, Tatiana, Callaway, Natalia F., Pasricha, Malini, Al‐Moujahed, Ahmad, Vail, Daniel, Ji, Marco H., Kumm, Jochen, and Moshfeghi, Darius M.

Subjects
DIGITAL image processing, NEWBORN screening, IMAGING systems, NEWBORN infants, HOSPITAL maternity services
Abstract

Purpose: To compare neonatal eye screening using the red reflex test (RRT) versus the wide‐field digital imaging (WFDI) system. Methods: Prospective cohort study. Newborns (n = 380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericórdia de São Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide‐field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [κ] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results: While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide‐field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%–4.21%) with a PPV of only 7.69% (95% CI, 1.08%–38.85%). Overall, there was no agreement between screening modalities (κ = −0.02, 95% CI, −0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns. Conclusion: While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT. [ABSTRACT FROM AUTHOR]

Published
2021
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