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Adequacy of published screening criteria for retinopathy of prematurity
Deepa A Taranath1, Dickson D-S Oh2, Miriam C Keane2
1Departments of Ophthalmology, Flinders Medical Centre, South Australia, Australia.
Insights
Screening criteria for retinopathy of prematurity (ROP) vary globally. An Australian model using <30 weeks gestational age or <1500g birth weight may detect ROP cases while reducing unnecessary screenings.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Public health screening programs
Background:
- Retinopathy of prematurity (ROP) screening criteria differ worldwide.
- Current guidelines may lead to missed diagnoses or over-screening.
Purpose of the Study:
- To analyze the effectiveness of alternative screening criteria for ROP.
- To identify optimal criteria for ROP screening in preterm infants.
Main Methods:
- Retrospective data analysis of 1007 preterm infants (<32 weeks GA or <1500g BW).
- Evaluation of an alternative Australian screening model (<30 weeks GA or <1250g BW) and international criteria.
- Main outcome: detection of ROP.
Main Results:
- Some alternative criteria failed to identify 2 neonates with clinically significant ROP requiring laser treatment.
- The Australian model (<30 weeks GA or <1500g BW) would have screened these infants.
- This model reduced the number of screened infants by 24.9%.
Conclusions:
- Certain international ROP screening criteria risk missing significant cases.
- The proposed Australian criteria (<30 weeks GA and/or <1500g BW) are a viable option.
- Balancing detection rates and screening efficiency is crucial for ROP management.
Background:
Criteria for screening preterm infants for retinopathy of prematurity vary around the world. We aimed to analyse the efficacy of alternative screening criteria.
Design:
We collected retrospective data at a tertiary level neonatal nursery.
Participants:
Our participants were 1007 babies, born between 1997 and 2011, at <32 weeks gestational age or <1500 g birth weight (as recommended by the National Health and Medical Research Council in 1996), who had completed follow-up to full retinal vascularization, with defined presence or absence of retinopathy of prematurity.
Methods:
We determined whether disease would be detected using an alternative Australian screening model (gestational age <30 weeks or birth weight <1250 g) or screening criteria utilized in developed countries with similar standards of neonatal care.
Main Outcome Measures:
Detection of retinopathy of prematurity is our main outcome.
Results:
Using several of the alternative criteria, two neonates with clinically significant retinopathy of prematurity, one of whom required laser treatment to preserve sight, would not have been screened, and their disease may have gone undetected. Use of <30 weeks gestational age or <1500 g birth weight as the criteria would still have screened these infants but would have reduced the number of infants screened by 24.9%.
Conclusions:
Some commonly utilized international screening criteria for retinopathy of prematurity may risk clinically significant cases being missed and others may screen babies unnecessarily. Alternative criteria should be considered and '<30 weeks gestational age and/or <1500 g birth weight' appears a viable option.
