Related Experiment Video
Updated: Jun 3, 2026
Monitoring Dynamic Growth of Retinal Vessels in Oxygen-Induced Retinopathy Mouse Model
Published on: April 2, 2021
A paradigm shift in the prevention of retinopathy of prematurity
Talkad S Raghuveer1, Barry T Bloom
1Department of Pediatrics, University of Kansas Medical School-Wichita, and Pediatrix Medical Group, Wesley Medical Center, Wichita, KS 67214, USA. raghuveer.talkad3@gmail.com
Insights
Optimizing oxygen therapy alone is insufficient for preventing severe retinopathy of prematurity (ROP) in premature infants. Combining multiple interventions, like growth factors and supplements, may reduce ROP burden.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Perinatal Research
Background:
- Oxygen therapy is a known risk factor for retinopathy of prematurity (ROP).
- Despite current strategies to optimize oxygen use, severe ROP remains a significant concern in extremely low birth weight infants.
- New insights into ROP pathogenesis suggest additional interventions are needed.
Purpose of the Study:
- To explore interventions beyond optimized oxygen therapy to decrease severe ROP.
- To identify strategies for preventing Phase I and Phase II ROP.
- To propose a multimodal approach for ROP prevention.
Main Methods:
- Review of current clinical research and insights into ROP pathogenesis.
- Identification of potential interventions for Phase I ROP (e.g., erythropoietin, IGF-1, glucose control, omega-3).
- Identification of potential interventions for Phase II ROP (e.g., anemia treatment, photopic adaptation, vitamin E, omega-3).
- Consideration of the WINROP algorithm for risk identification.
Main Results:
- Optimizing oxygen saturation (85-93%) and titration has not eliminated severe ROP.
- Several interventions show potential for preventing early (Phase I) and proliferative (Phase II) ROP.
- The WINROP algorithm may aid in early identification of high-risk infants.
Conclusions:
- A combination of multiple interventions, alongside optimized oxygen therapy, may be necessary to reduce ROP in vulnerable infants.
- Further randomized clinical trials are required to validate these multimodal strategies before clinical implementation.
Abstract:
For more than 50 years it has been known that oxygen therapy can lead to retinopathy of prematurity (ROP). Recent clinical research has led many neonatologists to lower the target oxygen saturation alarm limits to 85-93% and to titrate the inspired oxygen in small increments. Despite efforts to optimize oxygen therapy, the number of cases of severe ROP remains high as more extremely low birth weight infants survive. Based on new insights into the pathogenesis of ROP, there are multiple interventions, in addition to optimizing oxygen therapy that may help decrease severe ROP. Interventions that have the potential to prevent phase I ROP (birth to ≤32 weeks PMA) include increasing retinal erythropoietin (exogenous rHuEPO) and serum IGF-1 (breast milk and/or exogenous IGF-1), maintaining serum glucose below 120 mg, and providing omega-3 supplements. Interventions with potential to prevent proliferative ROP in phase II (infants >32-34 weeks PMA) include treating anemia with a liberal policy of transfusion in premature infants with stage III ROP, photopic adaptation, vitamin E supplements (>34 weeks PMA), and omega-3 supplements. The WINROP algorithm has shown promise as a biomarker in the early identification of extremely low birth weight infants at high risk for proliferative ROP. As there is interplay of multiple factors in the causation of ROP, we suggest that the simultaneous application of some combination of multiple interventions, mentioned above, may reduce the burden of ROP in the most vulnerable infants. These concepts need study in well-designed randomized clinical trials before being incorporated into clinical practice.
