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Retinopathy of prematurity in practice. I: screening for threshold disease
R Brennan1, L Gnanaraj, D G Cottrell
1Department of Ophthamology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Insights
Retinopathy of prematurity (ROP) screening is time-consuming but beneficial. Current UK national screening criteria for ROP are effective, identifying babies needing treatment while minimizing missed cases.
Area of Science:
- Ophthalmology
- Neonatal care
- Public health screening
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Effective screening protocols are crucial for early detection and intervention.
Purpose of the Study:
- To evaluate an 11-year ROP screening program in Northern England.
- To determine gestational age and birth weight associations with ROP severity.
- To assess screening workload and the impact of modified inclusion criteria.
Main Methods:
- Prospective data collection on 484 infants screened between 1987-1998.
- Analysis of screening frequency, ROP stages, and treatment outcomes.
- Evaluation of screening workload per detected threshold ROP case.
Main Results:
- 41.9% of infants developed any ROP; 5.2% reached threshold ROP requiring treatment.
- An average of 2.3 examinations per infant were needed.
- 39 examinations were required to detect one threshold ROP case.
- Premature and low-birth-weight infants required more examinations.
Conclusions:
- ROP screening is resource-intensive but valuable due to treatment benefits.
- Current national screening criteria in the UK are deemed satisfactory.
- Modifying criteria could modestly reduce workload but risks missing critical cases.
Aims:
To review an 11-year period of screening for retinopathy of prematurity (ROP) in the north of England by a single ophthalmologist. To identify the gestational ages and birth weights of babies reaching different stages of ROP. To investigate the workload involved in screening to detect threshold ROP, and that the practical outcomes had narrower inclusion criteria for screening. To identify babies treated for threshold disease.
Methods:
During the period August 1987-October 1998, babies were screened according to the national guidelines and the results were prospectively entered onto a computerised database. These data were then systematically reviewed.
Results:
Data were available for 484 babies: 203 (41.9%) developed any ROP, 46 (9.5%) reached stage 3 ROP, and 25 (5.2%) reached threshold and were treated. Data on 425 babies showed them to require an average of 2.3 screening examinations per baby. It took an average of 39 screening examinations to detect one case of threshold ROP. The more premature and lighter birth weight babies required the most examinations. Therefore, restricting the inclusion criteria for screening would only have reduced the total number of screenings modestly and could have allowed us to miss two of our threshold cases who were both of 30 weeks gestational age and >1400 g birth weight.
Conclusions:
Screening is time consuming but worthwhile in view of the benefits of treatment. As applied to babies in the north of England, the current national screening criteria are satisfactory. The results of treatment of the babies identified in this study are presented in the accompanying paper.