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Costenbader Lecture. The factor of time in retinopathy of prematurity
1Casey Eye Institute, Department of Ophthalmology, Oregon Health and Science University, Portland, Oregon 97201-4197, USA. palmere@ohsu.edu
Insights
Time significantly impacts retinopathy of prematurity (ROP) understanding and treatment. Ongoing research, including randomized clinical trials, is crucial for managing ROP progression effectively.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Clinical Research
Background:
- Retinopathy of prematurity (ROP) is a complex condition with variable outcomes.
- Understanding the temporal aspects of ROP is critical for effective management.
- Clinical trials like CRYO-ROP and ETROP have provided insights into ROP's chronology.
Discussion:
- The timing of ROP interventions is increasingly guided by disease severity rather than strict timelines.
- The progression rate of ROP is a key variable influencing treatment decisions.
- Evolving knowledge necessitates adjustments in ROP screening schedules.
Key Insights:
- Time is an intrinsic factor throughout the clinical course of retinopathy of prematurity.
- Randomized clinical trials are highly effective for comparing ROP treatment strategies.
- Disease severity, not just time, dictates optimal intervention points in ROP management.
Outlook:
- Further randomized clinical trials are essential for optimizing ROP management.
- Investigating strategies for ROP cases unresponsive to current therapies is a priority.
- Continued research will refine the timing and approach to ROP examinations and treatments.
Purpose:
To analyze and discuss the relationship between the factor of time and our understanding of retinopathy of prematurity (ROP).
Methods:
The author calls upon 30 years of experience in clinical investigations of ROP to critically synthesize selected literature on ROP, with attention to the broad theme of time. Future opportunities for clinical research are also considered.
Results:
Although retinopathy of prematurity (ROP) ultimately is self-limited in its course, it is highly variable in its severity and outcome. Both the CRYO-ROP and the ETROP studies paid close attention to the chronology of ROP events; however, they approached the question of when to randomize eyes for treatment not simply according to a time definition, but rather according to disease severity characteristics. Still, results of both these studies can be reviewed from a time perspective, and indeed the pace of progression was one of the risk variables considered for ETROP randomization. The optimal schedule under which to perform eye examinations for active ROP is changing, as our understanding of this disease continues to improve.
Discussion:
The factor of time is interwoven throughout the clinical course of ROP. Randomized clinical trials have proven to be an extremely efficient scientific method of comparing alternative treatment strategies. In looking toward the future, further randomized clinical trials are needed to investigate rational clinical management of cases in which retinal ablative therapy fails to arrest ROP's progression.
