250 - Eye drop Instillation by Parents at Home to Facilitate Outpatient Eye Examination for Retinopathy of Prematurity

Poster Number: 250
Publication Number: 250.224

Jennifer Pak, Georgetown University School of Medicine, Washington, DC, United States; Kabir M. Abubakar, Georgetown University School of Medicine, Washington, DC, United States

Background: Retinopathy of prematurity (ROP) is the abnormal development of retinal vessels in preterm infants which can lead to severe visual impairment or blindness. Many premature infants require ophthalmology follow-up if the retinae have not fully matured at the time of discharge. Ophthalmology follow-up is crucial as these infants are at risk for poor visual development, especially if changes that require intervention are not detected in a timely manner. Adequate pupillary dilation is necessary for an optimal eye exam and requires installation of eye drops at least 1 hour prior to the exam in the doctor's office. This wait time increases the likelihood of exposure to other people and infection. During the COVID-19 pandemic, our NICU adopted a discharge policy of teaching parents how to instill eyes drops to their infants at home before leaving for the eye appointment, with the goal of reducing the wait time in the office prior to the examination.

Objective: To evaluate if instillation of eye drops by parents at home before going to the office will provide adequate pupillary dilation for optimal ROP exam of premature infants in the outpatient setting and reduce wait time in the ophthalmology office.

Design/Methods: Parents of all preterm infants needing follow-up ROP exam were provided with and taught how to instill eye drops at home before leaving for the ophthalmology appointment. Parents were given a paper log and documented the time and number of eye drops instilled. The ophthalmology office then documented check-in time, time of exam and adequacy of pupillary dilatation. A sample log is included (Figure 1).

Results: Of the 14 individual eyes that were dilated, 10 were adequately dilated when eye drops were instilled by parents. 2 eyes received only one eye drop but were adequately dilated. 2 eyes did not adequately dilate with two drops in each eye and required three drops prior to the subsequent follow-up. 2 eyes received two drops but did not dilate adequately. The average time from check-in to eye exam was 38 minutes.Conclusion(s): As premature infants are at higher risk for infection, a process to allow for efficient outpatient evaluation is necessary. 71% of eyes were adequately dilated when parents instilled the eye drops prior to the first follow-up appointment. Of the eyes that were not adequately dilated, when parents were instructed to increase the number of drops prior to the second follow-up, both eyes were adequately dilated. Our study shows that parents are capable of instilling eye drops to provide optimal dilation for the ROP exam, thus decreasing the time spent in the outpatient office.
ROP Log97EEFD93-CBA5-45E1-970D-114DAD81F2F6.jpegSample of log provided for parents to record date/time and number of eye drops instilled. The ophthalmology office recorded date/time of check-in, time of exam, and if pupillary dilation was adequate.