The use of digital imaging in the identification of skip areas after laser treatment for retinopathy of prematurity and its implications for education and patient care.

Purpose: To describe the utility of using wide-angle digital imaging in the training for retinopathy of prematurity with laser and in identifying common locations of skip areas that were present after initial panretinal photocoagulation with indirect ophthalmoscopy by ophthalmologists-in-training. Methods: Retrospective review of digital retinal images of 22 eyes of 12 infants who had undergone laser treatment for retinopathy of prematurity performed by ophthalmologistsin- training. Presence of skip areas was determined by masked review of photographs. The location of skip areas was classified based on two axes: 1) circumferential (in one of six clock-hour regions) and 2) radial (adjacent to the retinal ridge, adjacent to the ora serrata, or isolated patches of greater than one laser burn width). Results: A total of 30 skip areas were identified in the 22 eyes treated with laser photocoagulation. Based on the circumferential location, a significant difference in skip area distribution was found (P = 0.02). Regions with the highest percentage of skip areas were between the clock hours 11: 00 to 1: 00 (45%) and 5: 00 to 7: 00 (41%). Based on the radial location, 40% of all skip areas were found near the ora serrata, 17% near the ridge, and 43% as isolated patches (P = 0.14). Conclusion: Skip areas after indirect panretinal laser photocoagulation by ophthalmologists-in-training were easily visualized by wide-angle digital imaging, after being missed by the trainee during the initial treatment procedure. Most skip areas in this study occurred in the superior or inferior retina. Digital imaging can assist ophthalmologists in visualizing all regions of the retina, can identify inadequate areas of laser treatment, and may reduce the need for retreatment after initial laser for retinopathy of prematurity.