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Results of screening low-birth-weight infants for retinopathy of prematurity
Insights
Retinopathy of prematurity (ROP) is a leading cause of preventable blindness. Advances in screening, treatment like laser therapy, and understanding ROP
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) remains a significant global cause of preventable childhood blindness.
- Emerging "third epidemic" of ROP in middle-income countries mirrors past challenges in developed nations.
- Current screening guidelines in the UK and US use birth weight and gestational age, with potential for refinement.
Purpose of the Study:
- To review current understanding and management strategies for retinopathy of prematurity.
- To discuss evolving screening criteria and treatment modalities for ROP.
- To highlight advancements in understanding ROP pathogenesis and long-term outcomes.
Main Methods:
- Review of population-based follow-up studies, including the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP).
- Analysis of emerging evidence on laser therapy versus cryotherapy for threshold ROP.
- Examination of new information on ROP pathogenesis, including genetics and vascular endothelial growth factor.
Main Results:
- Survival rates for extremely preterm infants are increasing, with potential declines in ROP-related blindness due to screening and treatment.
- Higher stages of ROP correlate with increased risks of myopia and strabismus.
- Laser therapy may offer better visual outcomes than cryotherapy for threshold ROP, though complications are a concern.
Conclusions:
- Continued refinement of ROP screening criteria is needed to optimize efficiency without compromising disease detection.
- Advancements in treatment and a deeper understanding of ROP pathogenesis, including genetic factors, are crucial for combating this condition.
- Effective screening and treatment are vital for reducing blindness from retinopathy of prematurity, especially in vulnerable populations.
Abstract:
Retinopathy of prematurity (ROP) continues to be an important cause of potentially preventable blindness worldwide. The pattern of visual impairment from ROP in some middle-income countries--high rates affecting larger and more mature infants--resembles that seen in more developed countries two decades ago and has been called a "third epidemic" of the disease. Expert bodies in the United Kingdom and the United States have recently issued new guidelines for screening for ROP that utilize both birth weight and gestational age criteria. Studies in both countries suggest these criteria might be further revised to decrease time spent on screening without missing any significant disease. Population-based follow-up studies of extremely preterm infants suggest that although more preterm infants are surviving, with adequate screening and treatment, rates of blindness from ROP may be declining. Further information on the longer-term impact of ROP comes from a number of studies and particularly the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) study. The risk of both myopia and strabismus is increased with any and each higher stage of ROP. Evidence is emerging that laser therapy for threshold disease may be associated with better visual outcome than cryotherapy, although complications following the former remain a concern. The fight against ROP may be enhanced by new information on the pathogenesis, including possible genetic predisposition and the role of vascular endothelial growth factor.
