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Retinopathy of prematurity: A systematic review of the literature
Insights
Infants born weighing 1500g or less, or at 30 weeks gestational age or younger, are at high risk for retinopathy of prematurity (ROP). Early diagnosis and timely treatment are crucial to prevent blindness.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of blindness in premature infants.
- Timely diagnosis and treatment are essential to prevent severe visual impairment.
Purpose of the Study:
- To assist in the diagnosis of retinopathy of prematurity (ROP).
- To facilitate timely treatment and prevent blindness.
Main Methods:
- Systematic review of MEDLINE and bibliographies.
- Included eight population-based studies on ROP incidence and severity.
- Analyzed data cumulatively for incidence and individually for natural history and treatment.
Main Results:
- Infants at highest risk: birth weight ≤1500g or gestational age ≤30 weeks.
- Inverse relationship between ROP incidence/severity and birth weight/gestational age.
- ROP onset typically 4-6 weeks, aggressive 'rush disease' as early as 3 weeks; maximum severity around 11 weeks.
- Long-term follow-up for refractive errors effective at 6-12 months and 4 years.
Conclusions:
- Very premature or very low birth weight infants are at highest risk for ROP.
- An optimal screening schedule and long-term follow-up strategy are recommended based on published data.
Objective:
To assist in the diagnosis of retinopathy of prematurity (ROP) to facilitate treatment in a timely manner to help prevent blindness.
Data Sources:
Systematic review using MEDLINE including the following key words, "retinopathy of prematurity", "retrolental fibroplasia", "blind", "blindness", "vision screening", "cryotherapy", "cryosurgery", "laser" and "ablative therapy". The bibliographies of the references found using the above techniques were scanned for references missed in the primary search.
Data Selection:
Eight population-based studies examining the incidence and severity of ROP were identified. Other studies of ROP were included because they contributed to an understanding of the natural history, treatment or long term outcome of ROP.
Data Extraction:
Data was analyzed cumulatively from the population-based studies to determine the incidence of ROP. For the natural history, treatment and schedule of eye examinations, data was reported from individual studies.
Data Synthesis:
Infants at greatest risk of ROP were 1500 g or less at birth, or 30 weeks gestational age or younger. An inverse relationship existed between the incidence and severity of ROP and birth weight or gestational age. The age of onset of ROP was four to six weeks; however, a few newborns presented with an aggressive form of ROP called 'rush disease' as early as three weeks of age. For those requiring treatment for ROP, the maximum severity was about 11 weeks of age. Long term follow-up for refractive errors was more effective between six and 12 months and again at four years.
Conclusion:
Very premature or very low birth weight infants are at highest risk of ROP. Based upon published information, an optimal screening schedule is recommended and a long term follow-up strategy is provided.
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