Can a Risk Factor Based Approach Safely Reduce Screening for Retinopathy of Prematurity?

Area of Science:

• Neonatal ophthalmology
• Perinatal medicine
• Public health screening

Background:

• Current American guidelines for retinopathy of prematurity (ROP) screening lack precision for infants born at ≥ 30 weeks gestation with birth weights between 1500 and 2000 grams.
• There is a need for a more refined screening strategy to avoid unnecessary examinations in premature infants at low risk for severe ROP.

Purpose of the Study:

• To evaluate the efficacy of a risk factor-based approach for screening premature infants at low risk for severe ROP.
• To determine if a targeted screening strategy can reduce the number of infants undergoing ROP screening examinations.

Main Methods:

• A 13-year retrospective review of data from Intermountain Health Care (IHC) was conducted.
• Neonates born at ≤ 32 weeks gestation were analyzed for ROP screening and development of severe ROP (defined as stage ≥ 3 or requiring laser therapy).
• Regression analysis identified significant risk factors associated with severe ROP.

Main Results:

• Of 2791 eligible neonates (born ≤ 32 weeks), 9.3% (260) developed severe ROP.
• Among infants born at ≥ 29 weeks gestation (n=1601), only 0.7% (11) had severe ROP, and all possessed at least two identified ROP risk factors.
• Implementing a risk-based screening strategy could have reduced screening by 21% (343/1601) in the studied population.

Conclusions:

• Limiting ROP screening for infants born at 29 to 32 weeks gestation to those with identified clinical risk factors is a viable strategy.
• This approach significantly reduces the number of screening examinations required while ensuring that all infants with severe ROP are identified.