Preterm Infant Stress During Handheld Optical Coherence Tomography vs Binocular Indirect Ophthalmoscopy Examination for Retinopathy of Prematurity

Abstract

Importance: Binocular indirect ophthalmoscopy (BIO) examination for retinopathy of prematurity (ROP) is a well-known cause of repeated preterm infant stress.

Objective: To compare stress during investigational optical coherence tomography (OCT) imaging to that during BIO for ROP.

Design, setting, and participants: This cross-sectional study examined infants at the bedside in the intensive care nursery. Consecutive preterm infants enrolled in Study of Eye Imaging in Preterm Infants (BabySTEPS) who had any research OCT imaging as part of the study. Patients were recruited from June to November 2019, and analysis began April 2020.

Main outcomes and measures: Infant stress was measured using modified components of a neonatal pain assessment tool before (baseline) and during OCT imaging and BIO examination of each eye.

Results: For 71 eye examinations of 16 infants (mean [SD] gestational age, 27 [3] weeks; birth weight, 869 [277] g), change from baseline to each eye examination was lower during OCT imaging than during BIO and the difference between OCT imaging and BIO at each eye examination was significant for the following: infant cry score (first eye examination: mean [SD], 0.03 [0.3] vs 1.68 [1.2]; -1.65 [95% CI, -1.91 to -1.39]; second eye examination: mean [SD], 0.1 [0.3] vs 1.97 [1.2]; -1.87 [95% CI, -2.19 to -1.54]), facial expression (first eye: 3 [4%] vs 59 [83%]; -79% [95% CI, -87% to -72%]; second eye: 4 [6%] vs 61 [88%]; -83% [95% CI, -89% to -76%]), and heart rate (first eye: mean [SD], -7 [16] vs 13 [18]; -20 [95% CI, -26 to -14]); second eye: mean [SD], -3 [18] vs 20 [20] beats per minute; -23 [95% CI, -29 to -18]) (P < .001 for all). Change in respiratory rate and oxygen saturation did not differ between OCT imaging and BIO.

Conclusions and relevance: While the role of OCT alone or in combination with BIO is currently unknown for ROP, these findings suggest that investigational OCT imaging of ROP is less stressful than BIO examination by a trained ophthalmologist.

Conflict of interest statement

Conflict of Interest Disclosures: Drs Prakalapakorn and Maguire report grants from the National Eye Institute during the conduct of the study. Dr Freedman reports personal fees from Qlaris Bio as a consultant outside the submitted work. Dr Toth reports grants from the National Institutes of Health and Research to Prevent Blindness during the conduct of the study; personal fees from Theia Imaging (owner equity) outside the submitted work; reports unlicensed patents for optical coherence tomography technology and methods pending and issued, a patent for Surgical Technologies with royalties paid from Alcon Laboratories through her university, and a patent for viscoelastic properties with royalties paid from Hemasonics through her university. No other disclosures were reported.

Figures

Figure 1.. Infants With Change in Behavioral Measures of Stress From Baseline to During First and Second Eye OCT Imaging/BIO Examination

Baseline values were reported within 10 minutes before the optical coherence tomography (OCT) imaging/binocular indirect ophthalmoscopy (BIO) examination.

Figure 2.. Change in Physiologic Measures of Stress From Baseline to During First and Second Eye OCT Imaging/BIO Examination

Baseline values were reported within 10 minutes before optical coherence tomography (OCT) imaging/binocular indirect ophthalmoscopy (BIO) examination.