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Published on: December 31, 2015
Importance of the 'third criterion' for retinopathy of prematurity screening in developing countries
Rajvardhan Azad1, Parijat Chandra, Sourabh D Patwardhan
1Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Insights
American screening guidelines for retinopathy of prematurity may miss some infants. A modified approach including neonatologist referral of high-risk infants is suggested for better detection in developing countries.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Current American screening guidelines for ROP may not be optimal for developing countries due to resource limitations.
Purpose of the Study:
- To evaluate the effectiveness of American screening guidelines for retinopathy of prematurity in a developing country context.
- To determine if modifications are needed to improve ROP detection rates.
Main Methods:
- Analysis of 1,302 eyes in 651 infants with ROP.
- Assessment using American guidelines based on gestational age and birth weight.
- Inclusion of a "third criterion" for neonatologist referral of high-risk infants.
Main Results:
- The American guidelines missed 6.6% of eyes (86/1,302).
- Of the missed eyes, 2.9% (38/1,302) had potentially treatable or severe retinopathy of prematurity.
- The "third criterion" helped include larger infants missed by standard guidelines.
Conclusions:
- The American screening guidelines for retinopathy of prematurity are largely appropriate for developing countries, even with modifications.
- A "third criterion" for neonatologist referral enhances screening but a small number of infants may still be missed.
- Resource and manpower constraints in developing countries support the use of adapted American guidelines.
Purpose:
Developing countries often need a modification of the American screening guidelines for retinopathy of prematurity.
Methods:
A total of 1,302 eyes in 651 infants with retinopathy of prematurity were analyzed by the parameters of gestational age and birth weight suggested by the American guidelines.
Results:
With the use of current gestational age and birth weight guidelines, 86 of 1,302 eyes (6.6%) were missed, and 38 of these eyes (2.9%) had potentially treatable or more severe retinopathy of prematurity and were in need of treatment.
Conclusion:
Use of the "third criterion" (ie, neonatologist referral of sick infants who were believed to be at high risk for retinopathy of prematurity), enabled larger infants who were otherwise missed by the American guidelines to be included for screening. Even when the parameters were increased, a relatively small number of infants was still missed. Therefore, in view of the limited resources and manpower in developing countries, the American screening guidelines are appropriate.
