Screening Procedure for Retinopathy of Prematurity

This study aimed at a critical analysis of literature on whether ROP screening is painful and distressing to the infant and the role of topical anaesthetics, oral sucrose and other methods like swaddling and nesting in reducing pain during the screening. The sources included journals and MEDLINE articles from 1989-2005. Only studies, which showed a clear outcome, were included. Those studies, which included very small sample size and indefinite outcomes, were excluded.1. Pupillary dilatation with either Guttae cyclopentolate 0.5% or Guttae cyclopentolate 0.5% with guttae phenylephrine 2.5%. Weaker solutions such as cyclopentolate 0.2% in combination with phenylephrine 1.0% may also be used. All mydriatic eyedrops should be instilled at least 30 minutes prior to examination.A mixture of tropicamide 0.5 % phenylephrine 2.5 % may also be used, which is instilled 3 times at intervals of 10 minutes for 1 hour before the scheduled examination. Tropicamide has lesser side effects when compared to cyclopentolate, and thus, may be preferred (Azad V, Pal N, 2005.)The use of an eyelid speculum and scleral indentor is not mandatory for routine screening. Applying a speculum is optional for experienced physicians (Azad V, Pal N, 2005). However, they are widely used and allows visualization of the mostperipheral regions of the retina, which is important in determining whether the nasal retina is fully vascularized (i.e. zone 2 or 3). Preferably, topical anaesthetic eye drops are instilled prior to inserting the eyelid speculum. But the choice of using a local anaesthetic is personal (Azad V, Pal N, 2005.)The presence of a neonatologist is a must to handle any emergencies like bradycardia or a decrease in oxygen saturation. Care must be taken to make sure that the baby has not had a feed immediately before the exam since the baby might vomit or aspirate, especially if cyclopentolate is used as the mydriatic.