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Global Disparities in Retinopathy of Prematurity: A Literature Review
Ishrat Ahmed1, Sandra Hoyek1, Nimesh A Patel1
1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, USA.
Insights
Retinopathy of prematurity (ROP) treatment varies globally, with anti-VEGF injections trending in high-income nations and laser therapy in middle-income countries. Increasing ROP incidence necessitates optimized screening, including AI and telemedicine, especially in resource-limited areas.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) poses a growing global threat to infant vision.
- Screening, diagnosis, and treatment of ROP face significant worldwide challenges.
Approach:
- A systematic literature review analyzed ROP treatment trends from 2011-2021.
- Studies were categorized by country income level, focusing on treatment modalities, surgical outcomes, and screening technologies.
- Keywords included retinopathy of prematurity, laser therapy, and anti-vascular endothelial growth factor (VEGF).
Key Points:
- Intravitreal anti-VEGF injections are increasingly the primary ROP treatment globally, especially in high-income countries.
- Laser therapy remains the preferred treatment for recurrent ROP in middle-income countries.
- Surgical outcomes for advanced ROP (stages 4A, 4B, 5) are consistent worldwide, but ROP incidence and visual impairment are rising.
Conclusions:
- ROP screening and treatment strategies differ significantly across countries due to resource disparities and lack of uniform guidelines.
- Telemedicine and artificial intelligence show promise for improving ROP screening in underserved regions, but require further adaptation.
- Addressing global ROP requires tailored approaches considering economic factors and technological integration.
Purpose:
To provide an overview of the impact of retinopathy of prematurity (ROP), and the challenges in the screening, diagnosis, and treatment of ROP worldwide.
Methods:
A comprehensive search was conducted using the PubMed database from January 2011 to October 2021 using the following keywords: retinopathy of prematurity, laser, and anti-vascular endothelial growth factor (VEGF). Data on patient characteristics, ROP treatment type, and recurrence rates were collected. The countries included in these studies were classified based on 2021-2022 World Bank definitions of high, upper-middle, lower-middle, and low-income groups. Moreover, a search for surgical outcomes for ROP and screening algorithms and artificial intelligence for ROP was conducted.
Results:
Thirty-nine studies met the inclusion criteria. ROP treatment and outcomes showed a trend towards intravitreal anti-VEGF injections as the initial treatment for ROP globally and the treatment of recurrent ROP in high-income countries. However, laser remains the treatment of choice for ROP recurrence in middle-income countries. Surgical outcomes for ROP stage 4A, 4B and 5 are similar worldwide. The incidence of ROP and ROP-related visual impairment continue to increase globally. Although telemedicine and artificial intelligence offer potential solutions to ROP screening in resource-limited areas, the current models require further optimization to reflect the global diversity of ROP patients.
Conclusion:
ROP screening and treatment paradigms vary widely based on country income group due to disparities in resources, limited access to care, and lack of universal guidelines.
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