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Pain in neonates during screening for retinopathy of prematurity using binocular indirect ophthalmoscopy and wide-field digital retinal imaging: a randomised comparison.
  1. Catharine Ann Dhaliwal1,*,
  2. Elizabeth Wright2,
  3. Neil McIntosh3,
  4. Kanwaldeep Dhaliwal1,
  5. Brian W Fleck4
  1. 1 University of Edinburgh, United Kingdom;
  2. 2 Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom;
  3. 3 Department of Child Life and Health, Edinburgh, United Kingdom;
  4. 4 Royal Hospital for Sick Children, Edinburgh, United Kingdom
  1. Correspondence to: Catharine Ann Dhaliwal, Centre for Reproductive Biology, University of Edinburgh, Room W1.12,, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom; cdhaliwa{at}


Objective: To compare the pain experienced by premature infants undergoing screening for retinopathy of prematurity (ROP) by wide-field digital retinal imaging (WFDRI) and binocular indirect ophthalmoscopy (BIO).

Methods: Infants were recruited at Edinburgh Royal Infirmary Neonatal Unit. Eyes were examined by both WFDRI and BIO with eyelid speculum by two experienced paediatric ophthalmologists in random order. We measured pain using the Premature Infant Pain Profile (PIPP).

Results: We recruited 76 infants. The mean PIPP score was 15.0 for WFDRI and 15.2 for BIO (difference not statistically significant). We observed that infants started crying with corresponding physiological changes as soon as the eyelid speculum was inserted and crying stopped on speculum removal.

Conclusion: WFDRI and BIO with eyelid speculum are similarly painful for infants. We suggest that the eyelid speculum rather than the examination method may contribute most to the pain experienced.

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