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Retinopathy of prematurity treatment: Asian perspectives
Parveen Sen1, Wei-Chi Wu2, Parijat Chandra3
1Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.
Insights
Retinopathy of prematurity (ROP) is a leading cause of preventable blindness in premature infants, particularly in Asia. Early screening and accessible treatments like laser photocoagulation and anti-VEGF injections are crucial for managing this condition.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a vasoproliferative disease affecting premature infants, potentially causing irreversible vision loss.
- Asia is currently experiencing a significant 'third ROP epidemic', highlighting an urgent public health concern.
- Effective screening and management are vital for preventing ROP-related blindness.
Purpose of the Study:
- To summarize the current Asian experience and approaches to managing retinopathy of prematurity (ROP).
- To highlight the challenges and advancements in ROP care within Asian middle-income countries.
- To provide insights into the effectiveness of various treatment modalities used in the region.
Main Methods:
- Review of existing literature and clinical practices concerning ROP management in Asian countries.
- Analysis of screening strategies, including the increasing use of tele-screening.
- Examination of treatment modalities such as laser photocoagulation, intravitreal anti-VEGF agents, and surgical interventions.
Main Results:
- Laser photocoagulation under topical anesthesia is a common treatment in Asia, differing from Western practices.
- Intravitreal anti-VEGF agents show effectiveness in ROP management, despite ongoing controversy.
- ROP surgeries are concentrated in a few tertiary centers, with late presentations and advanced retinal detachments being common.
Conclusions:
- Accessible screening programs are essential for preventing ROP-induced blindness in premature infants across Asia.
- A combination of established and emerging treatments, adapted to regional resources, is key to improving ROP outcomes.
- Addressing challenges like surgeon training and resource allocation is critical to combat the ROP epidemic in Asia.
Abstract:
Retinopathy of prematurity (ROP) is a vasoproliferative disease of developing retinal vessels that affects premature infants and can lead to severe and irreversible visual loss if left untreated. India and some other Asian countries are in the middle of a 'third ROP epidemic'. Blindness due to ROP is largely preventable if appropriate, adequate and accessible screening programmes are available. Screening of the premature babies is the first step in ROP management. With the increase in use of tele-screening techniques, more premature babies have been brought under the screening network both from urban and rural regions. Laser photocoagulation to the avascular retina using indirect ophthalmoscopy delivery system is the gold standard for ROP treatment and is usually done under topical anaesthesia in the Asian region in contrast to the western world. Use of intravitreal anti-vascular endothelial growth factors (VEGF) although controversial in management of ROP has been found to be effective in various Asian studies as well. ROP surgery in India and other middle-income Asian countries is largely performed only in few tertiary eye care centres. Poor visual prognosis, late presentation with advanced retinal detachments, lack of adequate number of trained paediatric retinal surgeons and paediatric anaesthetists also contribute to this problem. This current paper summarizes the Asian experience of ROP management.
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