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other·ophthalmology, retina, pediatric ophthalmology, neonatology, clinical trial·PMC10350462

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

Clinical Ophthalmology (Auckland, N.Z.) · 9 authors, 4 centres

AI SUMMARY

FIDELITY 94%

POPULATION9 adults directly involved with ROP exams and infant stress reduction (premedical students, occupational therapist, physical therapist, neonatologist, pediatric anesthesiologist, pediatric ophthalmologist, retinal specialist)

INTERVENTION15 components of ROP staging examinations including lid speculum, various scleral depressors, indirect ophthalmoscopy, goniolens, direct ophthalmoscopy, and retinal photography (Phoenix ICON), with or without topical anesthesia (proparacaine 0.5%)

COMPARISONNumb (with topical anesthesia) vs. feeling (without topical anesthesia) conditions; different exam methods and brightness levels

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This study compared perceived pain and brightness in 9 adults undergoing 15 components of retinopathy of prematurity (ROP) staging exams. Topical anesthesia moderately reduced pain during on-globe lid speculum and scleral depressed indirect examination, and a synergistic augmentation between pain and brightness was observed. The findings support judicious use of topical anesthetic and limited ophthalmoscope brightness to reduce stress in infant ROP exams.

Full summary

3,818 CHARS

**Background:** Retinopathy of prematurity (ROP) staging examinations can cause substantial stress in premature infants, often leading to bradycardia and other adverse effects. Various methods exist for retinal examination, including indirect ophthalmoscopy with lid speculum and scleral depression, direct ophthalmoscopy through a goniolens, and retinal photography. The relative pain and stress of these methods have not been directly compared, especially in adults. This study aimed to compare perceived pain and brightness in adults undergoing components typical of infant ROP exams, with and without topical anesthesia, to inform stress reduction strategies.

**Methods:** This prospective study received IRB approval (WCG IRB #1345195). Nine adults (aged 23-77) with interest in infant ROP exam comfort were included; exclusion criteria were cardiac arrhythmias, retinal detachment, enucleation, pregnancy, or allergy to topical anesthetic or dilating drops. Each subject underwent 15 exam components in a fixed order: tropicamide 1% dilation, proparacaine 0.5% topical anesthesia, Alfonso lid speculum (numb and feeling), See-Through scleral depressor (numb and feeling), Runge metal scleral depressor (numb and feeling), full-brightness indirect ophthalmoscopy (4000 lux) with See-Through depressor (numb), Moria wire speculum (numb), Moria vectis-style scleral depressor (numb), Runge 3D-printed plastic scleral depressor (numb), Koeppe goniolens insertion (numb), direct ophthalmoscopy through goniolens (numb), and Phoenix ICON Go retinal photography (numb). Pain and brightness were scored on a 1-10 Likert scale. Heart rate was monitored continuously with a VivaLNK Bluetooth adhesive electrocardiac monitor. Oculocardiac reflex (OCR) was calculated as exam heart rate divided by pre-exam heart rate. Statistical analysis included t-tests and ANOVA.

**Key Results:** Nine subjects completed all 15 components. Topical anesthesia significantly reduced pain scores: lid speculum numb median 2 (IQR 2,2) vs. feeling 6 (IQR 5,7); See-Through scleral depressor numb median 4 (IQR 3,4) vs. feeling 7 (IQR 6,7); Runge metal depressor numb median 3 (IQR 2,4) vs. feeling 8 (IQR 7,8). Brightness scores were also lower with anesthesia: See-Through depressor numb median 6 (IQR 5,7) vs. feeling 9 (IQR 7,9). Full-brightness indirect (4000 lux) with numb eye gave pain median 4 (IQR 4,5) and brightness 9 (IQR 9,10). The Phoenix ICON Go camera (numb) scored pain median 4 (IQR 3,4) and brightness 10 (IQR 9,10). Direct ophthalmoscopy through goniolens (numb) scored pain median 3 (IQR 2,4) and brightness 7 (IQR 6,8). Tropicamide 1% alone scored pain median 4 (IQR 3,4). OCR ranged from 98.8% to 102.1% across all methods, with no significant difference (F(14,120)=1.39, p=0.17) and no subject reached the 20% drop defining oculocardiac reflex. A synergistic trend was observed: brightness scores were higher when pain was higher, and pain scores trended higher with brighter illumination.

**Clinical Implications:** This study demonstrates that topical anesthesia provides moderate pain reduction during on-globe lid speculum and scleral depressed indirect examination, typical of ROP staging exams. The synergistic augmentation between pain and brightness suggests that minimizing both noxious stimuli is beneficial. Adults did not exhibit the bradycardia typical in infants, highlighting differences in autonomic response. The findings support judicious use of topical anesthetic and limited ophthalmoscope brightness to reduce stress in infant ROP exams. The study also notes that dilating drops (tropicamide) cause substantial discomfort, and that non-contact imaging methods may be less stressful. Limitations include fixed order of exam components, use of adult-sized goniolens, and small sample size (n=9).

PICO

PPOPULATION

9 adults directly involved with ROP exams and infant stress reduction (premedical students, occupational therapist, physical therapist, neonatologist, pediatric anesthesiologist, pediatric ophthalmologist, retinal specialist)

IINTERVENTION

15 components of ROP staging examinations including lid speculum, various scleral depressors, indirect ophthalmoscopy, goniolens, direct ophthalmoscopy, and retinal photography (Phoenix ICON), with or without topical anesthesia (proparacaine 0.5%)

OOUTCOME

Pain score (1-10 Likert), brightness score (1-10 Likert), oculocardiac reflex (OCR) as percent of pre-maneuver heart rate

STUDY TYPE

other

SPECIALTY

ophthalmology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

94% · A

ORIGINAL PAPER

PMC10350462

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

Clinical Ophthalmology (Auckland, N.Z.)

READ THE FULL PAPER

ABSTRACT

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

CITATION EXPORT

Laney J Cuddihee, Peter Giannulis, Sarah Merriner et al.. Compared Methods for Reducing Stress in ROP Exams; Stake-Holding Examiner Perspective. Clinical Ophthalmology (Auckland, N.Z.). (2023). https://doi.org/10.2147/OPTH.S418150

AUTHORS

9 · 4 CENTRES

Laney J Cuddihee, Peter Giannulis, Sarah Merriner, Paul E Runge, Victoria Pringels, Virginia McGill, Mary-Alice Johnson, Lindsey B Cobb, Robert W Arnold

1Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
2International Retinal Consultant, Lakewood Ranch, FL, USA
3Neonatal Intensive Care Unit, Providence Alaska Medical Center, Anchorage, AK, USA
4Anesthesiology Department, Central Peninsula Hospital, Soldotna, AK, USA