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Retinopathy of prematurity: screening and optimal use of the ophthalmologist's time
1Paediatric Department, Christchurch Hospital, New Zealand.
Insights
Screening for retinopathy of prematurity (ROP) in premature infants needs reassessment. A revised protocol focuses on earlier ROP screening for high-risk infants, improving early detection and preventing visual impairment.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Indirect ophthalmoscopy is standard for retinopathy of prematurity (ROP) screening in very low birthweight infants between 6-9 weeks.
- ROP is a leading cause of visual impairment in premature infants.
- Recent data suggest current screening timings may not be optimal for all risk groups.
Purpose of the Study:
- To reassess the optimal timing for initial ROP screening examinations.
- To propose a revised screening protocol based on infant risk factors.
- To improve early detection and management of ROP.
Main Methods:
- Retrospective review of 85 infants screened for ROP over two years.
- Analysis of ROP incidence and severity based on birthweight and gestational age.
- Literature review on ROP natural history and treatment efficacy.
Main Results:
- 34% of infants developed acute ROP, and 2.4% developed cicatricial disease.
- One infant born at 26 weeks gestation had stage 4 ROP when first seen at 11 weeks, indicating delayed detection.
- Current screening protocols may miss critical ROP stages in some high-risk infants.
Conclusions:
- A revised ROP screening protocol is proposed, stratifying infants by birthweight and gestational age.
- Earlier screening at 6 weeks is recommended for infants <1000g or <28 weeks gestation.
- Targeted screening reduces burden on services and focuses on infants most at risk of severe visual handicap.
Abstract:
In recent years it has been standard practice to recommend that indirect ophthalmoscopy be carried out between six and nine weeks of age in very low birthweight infants to screen for the presence of retinopathy of prematurity (ROP). Following this recommendation we examined 85 infants over a two-year period. Acute ROP occurred in 29 (34%), and two (2.4%) developed cicatricial disease. One-third of infants were initially examined slightly earlier or later than the strict six to nine week limits, but all except three infants were examined between 35 and 42 weeks gestation. One infant born at 26 weeks gestation, was examined 'too late' in that she had stage 4 disease when first seen at 11 weeks of age. Recent information on the natural history of ROP, and confirmation of the efficacy of treatment with cyotherapy, suggested that the timing of an initial screening examination for ROP needed reassessment. From our experience and a review of the literature we recommended that infants of less than 1000 g birthweight or less than 28 weeks gestation have an initial examination at six weeks of age; for infants of 1000 to 1250 g birthweight or 28 to 30 weeks gestation examination continue to be at six to nine weeks of age; and for infants of more than 1250 g birthweight or 31 weeks gestation screening at six to nine weeks of age is only necessary if the infant has had an unstable course or prolonged oxygen requirements. Such a protocol would not place too great a burden on ophthalmological services and would direct efforts towards the group of infants most at risk of severe visual handicap.
