Compared Methods for Reducing Stress in ROP Exams; Stake-Holding Examiner Perspective

Abstract

Purpose

To better understand the sensory impact of retinal exam components typically experienced by infants undergoing various retinopathy of prematurity staging examinations, adults concerned for infant welfare and exam quality underwent similar exams to compare their perceived stress.

Patients and Methods

Adults directly involved with ROP exams and infant stress reduction had cardiac monitoring and concomitant ordinal self symptom-score (1–10 Likert) during 15 components of the exam including lid speculum, various scleral depressors, indirect ophthalmoscopy, goniolens and direct ophthalmoscopy and retinal photography (Phoenix ICON) with or without topical anesthesia.

Results

Nine adults provided impressions and cardiac rhythm gathered supine over 15 minutes. Pain score for topical anesthetic 2 was less than for tropicamide 4. Lid specula numb scored a median 2 level (from 1 to 10) pain but without anesthetic scored 6. The goniolens numb scored 3. Scleral depression numb scored 3–4 but increased to 7 without topical anesthesia. Direct ophthalmoscope scored 3 through the goniolens and the retinal camera scored 4 pain. Brightness with low 350 Lux indirect scored 6–8 numb and 9 brightness without anesthetic. Full bright indirect, direct ophthalmoscope and the retinal camera all had Lux of 3000–4000 and were scored brightness 9, 7 and 10, respectively. Adults had minimal oculocardiac reflex during on-globe retinal examination methods (range 98% to 102%).

Conclusion

Topical anesthesia provided a moderate reduction in pain during on-globe lid-speculum, scleral depressed indirect examination. There was a synergistic augmented sensory response between pain and brightness. Adults did not show the bradycardia typically elicited by retinal examinations in premature infants.

Keywords:

• retinopathy of prematurity
• infant pain
• bradycardia
• scleral depression
• imaging

Abbreviations

Gonioscopy (gonio), model of portable Phoenix retinal camera ICON Go; IQR, Inter-quartile range; NICU, neonatal intensive care unit; OCR, Oculocardiac reflex; PIPP, Premature Infant Pain Profile; ROP, retinopathy of prematurity; SD, standard deviation; Please see Table 1.

Data Sharing Statement

Data Access: https://www.abcd-vision.org/references/ROP-Stress-DeID.pdf.

Disclosure

Dr Arnold is a board member of PDI Check, PEDIG, and Glacier Medical Software which owns a Phoenix ICON GO camera. Dr Robert W Arnold is a coordinator for Alaska Blind Child Discovery, during the conduct of the study; consultant for Neolight, outside the submitted work; In addition, Dr Robert W Arnold has patent Systems and Methods for Eye Evaluation and Treatment issued to Robert Arnold and Alex Damarjian; Drs Runge and Arnold have designed instruments for ROP examination, but receive no royalties. The authors report no other conflicts of interest in this work.

Additional information

Funding

There is no funding to report.