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Validation of the "TWO-ROP" Algorithm at a Multi-Neonatal Intensive Care Unit Tertiary Referral Center
Nimesh A Patel1, Francisco Altamirano2, Sandra Hoyek1
1Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
Purpose:
We aim to validate the previously published TWO-ROP algorithm on an external data set.
Design:
Retrospective consecutive study.
Subjects:
Infants screened for retinopathy of prematurity (ROP) between January 2013 and August 2023 at a tertiary referral multi-site.
Methods:
Infants with higher birth weight (BW) and greater gestational age (GA) were included and stratified into 3 groups as follows: group 1 (BW <1500 g, GA ≥30 weeks), group 2 (BW ≥1500 g, GA <30 weeks), and group 3 (BW ≥1500 g, GA ≥30 weeks).
Main Outcome Measures:
The rate of ROP, treatment-warranted ROP (TW-ROP), and number of inpatient examinations were evaluated in the 3 groups.
Results:
In total, 1095 (33.8%) patients met the inclusion criteria. The number of patients in groups 1, 2, and 3 was 837 (76.4%), 72 (6.6%), and 186 (17.0%), respectively. Retinopathy of prematurity was detected in 120 (11.0%) patients; the rate was 9.8% in group 1, 20.8% in group 2, and 12.4% in group 3 (P = 0.013). The overall mean number of inpatient examinations for patients undergoing traditional, TWO-ROP 36-week, and TWO-ROP 40-week screening systems was 1.95, 1.43, and 0.99, respectively (P < 0.001). Stage 3 was found in 9 eyes of 5 patients (0.5%, all zone II). Three eyes of 2 patients (0.2%) had plus disease. Two patients had bilateral laser treatment at 44 and 39.4 weeks postconceptional age (PCA); 3 out of 4 of these eyes met type 1 treatment criteria. Overall, the ROP screening burden saved was 9.0% and 16.7% for the TWO-ROP 36-week and 40-week systems, respectively. The sensitivity for TW-ROP was 100% for TWO-ROP 36-week system and 99.4% for TWO-ROP 40-week system.
Conclusion:
The TWO-ROP algorithm can reduce the number of inpatient examinations while maintaining safety. To ensure timely management, we recommend that the single first ROP examination occur at 38 to 39 weeks PCA.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
