A Standardized Bedside Screening Protocol for Retinopathy of Prematurity

Summary

This article primarily outlines the standard procedure for bedside screening for retinopathy of prematurity (ROP), which helps detect ROP early, enabling timely treatment and reducing the risk of blindness.

Abstract

Retinopathy of prematurity (ROP) screening is a time-sensitive, multidisciplinary clinical process that enables early detection of this vision-threatening disease while minimizing examination-related physiologic stress. This article describes a structured bedside workflow for ROP screening, including eligibility assessment, pre-examination preparation, retinal examination, differential diagnosis of uncertain findings, documentation, follow-up planning, referral, and post-examination care. Infants are selected for screening according to gestational age and birth weight criteria, with additional consideration given to clinically unstable infants considered at risk by the neonatology team. Before examination, parent communication, cardiorespiratory monitoring, pharmacologic mydriasis, and comfort measures are performed according to the screening workflow. Retinal evaluation is performed primarily by binocular indirect ophthalmoscopy combined with scleral depression, while adjunctive image documentation is obtained when available and clinically indicated. Examination findings are recorded according to the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), including zone, stage, and plus disease status, to support consistent classification and longitudinal comparison. Follow-up intervals, senior review, and referral for treatment evaluation are then assigned according to predefined decision criteria. This workflow may serve as a practical operational framework for bedside ROP screening in units seeking more uniform documentation and follow-up planning.

Introduction

Retinopathy of prematurity (ROP) is one of the major preventable causes of childhood blindness worldwide and primarily affects preterm infants and those with low birth weight¹. With advances in perinatal medicine and neonatal intensive care, increasing numbers of extremely preterm and extremely low-birth-weight infants now survive, and the burden of ROP therefore remains substantial, particularly in low- and middle-income countries². Without timely screening and intervention, ROP may progress to tractional retinal detachment and severe irreversible visual loss, and it is also associated with long-term ocular sequelae suc....

Protocol

This protocol describes a structured bedside ROP screening workflow for neonatal wards and the neonatal intensive care unit (NICU). The study was approved by the Ethics Committee of the Children’s Hospital, Zhejiang University School of Medicine (ID: 2021-IRB-026). All examinations were performed according to routine clinical practice, and written informed consent was obtained from the parents or legal guardians. A standardized parental informed consent form used in this protocol is provided in Supplementary File 1.

1. Determining screening eligibility

1. Identify infants eligible for screening. Re....

Results

Approximately 25 eyes underwent bedside ROP screening per week. The examination completion rate was 100%, and the average examination duration was 2–3 min per eye. Standardized report generation was completed in all screened cases, and follow-up assignment was completed for all cases. Adverse events, including apnea and allergic reactions, occurred only rarely, indicating good overall tolerability of the bedside workflow.

Figure 2 summarizes the overall workflow o.......

Discussion

This article describes a structured bedside workflow for retinopathy of prematurity (ROP) screening in neonatal wards and neonatal intensive care units (NICUs). The protocol integrates screening eligibility assessment, pre-examination preparation, bedside retinal examination, adjunct image acquisition when indicated, ICROP3-based documentation, follow-up planning, referral, and post-examination care into a single operational sequence. Rather than establishing a new diagnostic standard, the protocol is intended to provide.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
90D condensing lens	VOLK Optical Inc.	V503085	used for bedside retinal examination with binocular indirect ophthalmoscopy
Binocular indirect ophthalmoscope (YZ25C)	Suzhou 66 Vision Technology Co., Ltd.	V150981	bedside retinal examination
RetCam3	Natus Medical Incorporated	AZ23001062-0301	wide-field retinal imaging