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Retinopathy of prematurity screening criteria in Iran: new screening guidelines
Ramak Roohipoor1, Reza Karkhaneh1, Afsar Farahani1
1Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Existing retinopathy of prematurity (ROP) screening guidelines miss many cases in Iran. New criteria are proposed for Iranian premature infants to improve detection of ROP requiring treatment, ensuring better infant eye care.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Current international ROP screening guidelines may not be optimal for all populations.
Purpose of the Study:
- To evaluate the effectiveness of existing ROP screening guidelines in Iran.
- To develop and propose novel ROP screening criteria tailored for Iranian premature infants.
Main Methods:
- A prospective cohort study involving 1932 infants born at ≤37 weeks gestation or weighing ≤3000g.
- Infants were screened for ROP and need for treatment across multiple neonatal intensive care units and an eye hospital.
- Receiver operating characteristic curve analysis was used to determine optimal screening criteria.
Main Results:
- Applying international guidelines (e.g., American Academy of Pediatrics) missed 25.4% of ROP cases and 8.4% of treatment-requiring ROP in the Iranian cohort.
- Proposed criteria of gestational age ≤32 weeks or birth weight ≤2000g showed 100% sensitivity for detecting treatment-requiring ROP.
Conclusions:
- International ROP screening guidelines are inadequate for the Iranian population, leading to missed cases.
- New, localized screening criteria are necessary to ensure timely detection and treatment of ROP in Iranian premature infants.
Objective:
To test the applicability of existing retinopathy of prematurity (ROP) guidelines on Iranian patients and to develop novel ROP screening criteria in Iran.
Methods:
Both eyes of 1932 infants born ≤37 weeks of gestation and/or weighting ≤3000 g were included in this prospective cohort study that was conducted across nine neonatal intensive care units and a tertiary eye hospital ROP clinic. The patients were examined for ROP and the need for treatment (type 1 ROP or worse). All the patients were screened 4 weeks after birth or at 31 weeks of postmenstrual age, whichever was later. The patients were followed until retinal vascularisation was completed or the patients reached 50 weeks of gestational age (GA) without prethreshold ROP. A receiver operating characteristic curve was used to determine the best screening criteria for ROP. Screening criteria from other countries were applied to our patient data to determine their ability to appropriately detect ROP.
Main Outcome Measure:
Patients with ROP requiring treatment.
Results:
The mean GA±SD and birth weight (BW)±SD of the screened patients were 32±2.7 weeks and 1713±516 g, respectively. Using criteria of GA≤32 weeks or BW ≤2000 yielded sensitivity and specificity of 100% and 26.7%, respectively, for treatment requiring ROP regardless of clinical comorbidities. Using screening recommendations of American Academy of Pediatrics would miss 25.4% of ROP and 8.4%ROP requiring treatment in our cohort.
Conclusions:
Other countries screening recommendations would result in a significant amount of missed cases of treatment requiring ROP when applied to Iran. As a result, we have proposed new guidelines for premature babies in Iran.
