Original Article Efficacy of wide-field digital retinal imaging for retinopathy of prematurity screening Shuan Dai FRANZCO, 1 Kent Chow MBChB 1 and Andrea Vincent FRANZCO 1,2 1 Department of Ophthalmology, Greenlane Clinical Centre, and 2 Department of Ophthalmology, University of Auckland, Auckland, New Zealand ABSTRACT Background: To evaluate the efficacy of wide-field digital retinal imaging for retinopathy of prematurity screening. Design: Retrospective study in a quaternary public neonatal intensive care unit. Participants: A total of 108 premature infants screened for retinopathy of prematurity. Methods: Retrospective chart and photo review were performed on participants screened by both serial wide-field digital retinal imaging and concurrent binocular indirect ophthalmoscopy. Review of cap- tured digital photos was performed independently by a masked reader. Using the binocular indirect ophthalmoscopy findings as the gold standard, the efficacy of wide-field digital retinal imaging in detecting treatment-requiring retinopathy of prema- turity, defined as type 1 prethreshold disease, was determined. Main Outcome Measures: Sensitivity and specificity of wide-field digital retinal imaging in detecting treatment-requiring retinopathy of prematurity. Results: Treatment-requiring retinopathy of prema- turity was detected in 11 infants by both binocular indirect ophthalmoscopy examination and telemedi- cine images taken at the same visit. Wide-field digital retinal imaging has a sensitivity of 100% (95% CI: 76.2–100%) and a specificity of 97.9% (95% CI: 93.4–99.7%) in detecting infants with treatment- requiring retinopathy of prematurity. Positive and negative predictive values of wide-field digital retinal imaging were 84.6% (95% CI: 57.8–97.3%) and 100% (95% CI: 96.9–100%), respectively. Conclusions: Wide-field digital retinal imaging is accurate, reliable and efficient in detecting treatment- requiring retinopathy of prematurity. Incorporating wide-field digital retinal imaging with telemedicine in standard retinopathy of prematurity management can potentially improve delivery, accessibility, qual- ity and cost of retinopathy of prematurity care. Key words: diagnostic imaging, mass screening, pho- tography, retinopathy of prematurity. INTRODUCTION Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness. In the USA, approximately 1500 infants annually develop severe ROP that threatens sight and requires treatment. 1 As early detection and prompt treatment of severe ROP can significantly decrease the incidence of severe visual loss and adverse outcome, screening of at-risk infants has been the cornerstone of ROP management. 2 The delivery of quality ROP care has faced several challenges in recent years. First, the current gold standard method for ROP screening, binocular indirect ophthalmoscopy (BIO), is not completely ideal. Scleral depression required in BIO can cause systemic complications such as bradycardia second- ary to oculocardiac reflex, 3 as well as potentially serious ophthalmic complications such as vitreous and subretinal haemorrhages. 4,5 BIO is labour and time intensive for ophthalmologists, as well as  Correspondence: Dr Shuan Dai, Department of Ophthalmology, Greenlane Clinical Centre, Private Bag 92-189, Auckland District Health Board, Greenlane, Auckland, New Zealand. Email: shuan.dai@gmail.com Received 20 July 2009; accepted 10 June 2010. Clinical and Experimental Ophthalmology 2010; ••: ••–•• doi: 10.1111/j.1442-9071.2010.02399.x © 2010 The Authors Clinical and Experimental Ophthalmology © 2010 Royal Australian and New Zealand College of Ophthalmologists