Wide-angle fundus digital imaging may be more effective than red reflex exam in detecting potentially visually threatening posterior segment pathology in newborns, according to a study.
In the prospective Newborn Eye Screening Test (NEST) study, 194 healthy term newborns underwent both red reflex screening and wide-angle fundus digital imaging using a RetCam3 130° lens (Natus Medical). Red reflex screening was documented in pediatricians’ notes; digital imaging was performed by a trained neonatal intensive care unit nurse. The study included newborns in the NEST cohort screened from July 25, 2013, to July 25, 2014, at Lucile Packard Children’s Hospital at Stanford University School of Medicine.
In 49 infants in whom no abnormal findings were seen on red reflex screening, 130° wide-angle fundus imaging demonstrated one or more posterior segment abnormalities: retinal hemorrhages, macular hemorrhages, optic nerve flame hemorrhages, grouped pigmentation, choroidal nevus in the macula, choroidal nevus elsewhere in the retina, choroidal pigmentation, albinotic appearance of the choroid, polar bear tracks, pigmentary retinopathy and focal depigmentation of the retinal pigment epithelium.
Overall agreement between the two screening modalities was 81.4% to 99.5% for any one abnormality. For the detection of any pathology or any single pathology, the pediatrician’s red reflex exam had a sensitivity of 0%, “indicating a predominance of false-negative red reflex exams,” and specificity of 100% “due to an absence of false-positive red reflex exams,” the authors said.
The results show the potential for wide-angle fundus digital imaging in the detection of neonatal ocular pathology that may be missed by the red reflex exam, according to the study. – by Robert Linnehan
Disclosures: The authors report no relevant financial disclosures.