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Practice Patterns in Retinopathy of Prematurity Treatment for Disease Milder Than Recommended by Guidelines
Mrinali Patel Gupta1, R V Paul Chan1, Rachelle Anzures2
1Department of Ophthalmology, Weill Cornell Medical College/New York - Presbyterian Hospital, New York, New York.
Insights
Experts sometimes treat retinopathy of prematurity (ROP) milder than standard guidelines suggest. Clinical judgment plays a key role when evidence-based treatment thresholds are not met for ROP.
Area of Science:
- Ophthalmology
- Neonatal care
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Established guidelines recommend treatment for type 1 ROP, but expert practice for milder cases is less defined.
Purpose of the Study:
- To determine the frequency and clinical reasons for treating retinopathy of prematurity (ROP) that is milder than type 1 disease.
- To analyze expert decision-making beyond established treatment thresholds.
Main Methods:
- A multicenter descriptive analysis was performed.
- Data from 1444 eyes of infants screened for ROP were retrospectively reviewed.
- Identified infants treated for ROP milder than type 1 disease.
Main Results:
- 137 eyes of 70 infants were treated for ROP.
- 9.5% of treated eyes (13 eyes) had ROP milder than type 1.
- Indications included concerning structural changes, fellow eye treatment, persistent ROP, and vitreous hemorrhage.
Conclusions:
- Expert clinicians occasionally treat ROP milder than type 1.
- Clinical judgment is crucial in managing ROP cases not clearly defined by current guidelines.
- Highlights the need for nuanced approaches in ROP treatment decisions.
Purpose:
To characterize the frequency of and clinical indications for which experts treat retinopathy of prematurity (ROP) milder than type 1 disease, the recommended threshold for treatment from established consensus guidelines.
Design:
Descriptive analysis.
Methods:
setting: Multicenter.
Study Population:
A database of 1444 eyes generated prospectively from all babies screened for ROP at 1 of 6 major ROP centers whose parents provided informed consent.
Intervention:
Retrospective review of the database and charts to identify all patients treated for ROP milder than type 1.
Main Outcome Measure:
Indication(s) for treatment.
Results:
A total of 137 eyes of 70 infants were treated for ROP. Of these 137 eyes, 13 (9.5%) were treated despite a clinical diagnosis milder than type 1 ROP. Indications for treatment included active ROP with the fellow eye being treated for type 1 ROP (2 eyes, 15.4%); concerning structural changes (9 eyes, 69.2%), including tangential traction with temporal vessel straightening concerning for macular dragging (8 eyes, 61.5%) and thick stage 3 membranes with anteroposterior traction concerning for progression to stage 4 ROP (3 eyes, 23.1%); persistent ROP at an advanced postmenstrual age (4 eyes, 30.8%); and/or vitreous hemorrhage (3 eyes, 23.1%).
Conclusions:
Experts in this study occasionally recommended treatment in eyes with disease less than type 1 ROP. This study has important clinical implications and highlights the role of individual clinical judgment in situations not covered by evidence-based treatment guidelines.
