Screening for retinopathy of prematurity in developing countries

Area of Science:

• Ophthalmology
• Neonatology
• Public Health

Background:

• Improved survival rates for low birth weight, premature infants in India have led to a rise in retinopathy of prematurity.
• Existing Western screening criteria may not be suitable for Indian nurseries due to resource limitations.

Purpose of the Study:

• To develop an appropriate retinopathy of prematurity screening strategy for Indian neonatal intensive care units.
• To identify risk factors and optimal timing for screening in this population.

Main Methods:

• Retrospective review of ophthalmic records for 60 neonates (gestational age ≤35 weeks and/or birth weight ≤1500 g).
• Data collected included laterality, location, stage, age at detection/progression, and outcomes of retinopathy of prematurity.
• Analysis of disease progression and regression patterns based on retinal zones.

Main Results:

• Incidence of retinopathy of prematurity was 21.7% (13/60), with threshold disease in 5.0% (3/60).
• Threshold disease was not observed before 5.5 weeks post-neonatal age (PNA).
• Zone I disease invariably progressed, Zone II occurred in 12.5%, and Zone III did not progress to threshold. Most cases (76.9%) regressed spontaneously.

Conclusions:

• Screening for retinopathy of prematurity should begin at 4 weeks PNA.
• A modified screening approach (temporal first, nasal only if temporal is abnormal) can reduce examination time and infant discomfort.
• Babies with Zone III disease may not require follow-up for complete visualization, and specific indicators suggest intensive screening needs.