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Screening for retinopathy of prematurity in developing countries
Rohit Sharma1, Ved P Gupta, Upreet Dhaliwal
1Eye Unit, Luton and Dunstable Hospital, Luton, LU4 0ET, UK. rohity2ksharma@yahoo.com
Insights
Improved survival of premature infants has increased retinopathy of prematurity. A new screening strategy for Indian nurseries suggests starting screening at 4 weeks post-neonatal age, focusing on temporal retina first.
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.
Abstract:
Improved survival of low birth weight, premature babies in India has increased the incidence of retinopathy of prematurity. Western reports describe screening criteria to pick up babies most at risk. However, our population of at-risk neonates is likely to be different, as most nurseries in India are not very well equipped. Our aim was to develop a screening strategy appropriate for our conditions. Ophthalmic records of 60 neonates with gestational age < or =35 weeks and/or birth weight < or =1500 g, born over a 1-year period, were retrospectively reviewed. Laterality, location and stage of retinopathy of prematurity were recorded. Age at detection, at threshold disease and at maximum stage was recorded, and progression or regression of retinopathy noted. The incidence of retinopathy was 13/60 (21.7%) and of threshold disease was 3/60 (5.0%). Threshold disease was never seen before 5.5 weeks PNA. Zone I disease invariably, zone II disease in 12.5% cases and zone III disease never progressed to threshold stage. Most (10/13; 76.9%) cases regressed without treatment. Screening for retinopathy should commence at 4 weeks PNA (post-neonatal age). Screening time, discomfort to the baby and complications can be reduced by examining temporal retina first. If normal, the nasal retina need not be examined. Also, babies with zone III disease need not be followed up to complete visualization. Retinal vascular dilatation, resistance to pupillary dilation and persistence of tunica vasculosa lentis can be indicators of intensive screening.
