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Risk analysis and an alternative protocol for reduction of screening for retinopathy of prematurity
Michael B Yang1, Edward F Donovan
1Department of Ophthalmology/Abrahamson Pediatric Eye Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. Michael.Yang@cchmc.org
Insights
A new risk model efficiently screens premature infants for retinopathy of prematurity (ROP), reducing ROP screening frequency without compromising detection of severe ROP.
Area of Science:
- Ophthalmology
- Neonatology
- Biostatistics
Background:
- Retinopathy of prematurity (ROP) requires regular screening in premature infants.
- Current screening protocols can be resource-intensive.
- Identifying low-risk infants can optimize screening efficiency.
Purpose of the Study:
- To evaluate a multivariate risk model for selecting low-risk infants for an alternative ROP screening protocol.
- To assess if reduced screening impacts the effectiveness of ROP detection.
Main Methods:
- Retrospective, nonrandomized comparative study of 712 eyes from 357 premature infants (401-1,250 g birth weight).
- A risk model incorporating birth weight, gestational age, multiple birth, race, and gender was used.
- Simulations compared conventional screening with a 35q3 protocol for low-risk eyes.
Main Results:
- The 35q3 protocol reduced mean eye examinations by 13.4% (p = 0.0051).
- No delays in detecting threshold or type 1 zone 1 ROP.
- Two eyes with type 1 zone 2 ROP showed a 1-week delay but regressed without progression.
Conclusions:
- A risk-based ROP screening protocol enhances efficiency for premature infants (401-1,250 g) without compromising effectiveness.
- This approach requires further validation through multicenter studies.
Purpose:
To determine whether a multivariate risk model can select infants with low-risk eyes for an alternative protocol that reduces retinopathy of prematurity (ROP) screening without loss of effectiveness.
Methods:
This was a retrospective, nonrandomized, comparative study. We assigned 712 eyes of 357 premature infants of 401-1,250 g birth weights as high or low risk for prethreshold or threshold ROP using a risk model with variables of birth weight, gestational age, multiple birth, race, and gender. Using simulations, infants with high-risk eyes (p > or = 0.15) were screened conventionally, while those with low-risk eyes were screened with the 35q3 protocol (initial examination at 35 weeks postmenstrual age followed by screening every 3 weeks, with increased or decreased intervals based on ROP severity). The resultant reduction in ROP screening and the delay to detection of severe ROP were calculated.
Results:
The 35q3 protocol reduced the mean number of eye examinations per infant in the overall population by 13.4% (p = 0.0051). No eyes had a delay to the detection of threshold or type 1 zone 1 ROP. Of a total of 57 type 1 ROP eyes, 2 eyes with type 1 zone 2 ROP were delayed to detection by 1 week. As our study was done prior to the Early Treatment of ROP study, the 2 eyes were observed and regressed without progression to threshold ROP.
Conclusions:
A risk-based alternative screening protocol increased the efficiency of ROP screening for infants of 401-1,250 g birth weight without an apparent loss of effectiveness. This investigational approach requires further validation by multicenter studies.
