Table 1

Advantages and disadvantages of different approaches for ROP screening

Technology	Personnel	Main advantages	Disadvantages/Requirements
Indirect ophthalmoscopy	Skilled ophthalmologist.	Immediate diagnosis. Parents can be counselled.	No images to document signs and to use in health education, staff training and to track change over time. Takes ophthalmologists away from other clinical duties.
Wide field imaging	Skilled ophthalmologist takes and grades images at the cot side.	Immediate diagnosis. Parents can be counselled. Provides documentation.	Cost of wide-field imaging systems. Takes ophthalmologists away from other duties.
	Images taken by a trained non-ophthalmologist with image grading remotely by an ROP expert.	Requires less of the ophthalmologist’s time. Provides documentation; screening team can visit multiple NICUs using one device. Artificial intelligence has the potential to guide management decisions.	Cost of wide-field imaging systems. Good internet connection; systems to store and retrieve image. High image quality and robust systems for reporting and communicating management decisions to staff and parent.
	Images taken and initial grading by trained non-ophthalmologists (technicians, nurses) with quality control by an ROP expert.