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Screening for retinopathy of prematurity in China: a five-year cohort study in seven screening centers
Yusheng Zhong1, Xiacheng Lin1, Yating Yang1
1Department of Ophthalmology, Peking University People's Hospital, Beijing Key Laboratory of Ocular Disease and Optometry Science, Beijing, China.
Insights
Optimized screening for retinopathy of prematurity (ROP) in China suggests new guidelines. Lowering gestational age (GA) and birth weight (BW) criteria can reduce screening while maintaining high detection rates for ROP.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Current ROP screening guidelines in China may not reflect recent demographic shifts in premature infants.
Purpose of the Study:
- To analyze the demographic characteristics of infants diagnosed with ROP in China.
- To propose optimized screening criteria for ROP to improve guideline efficiency.
Main Methods:
- A multicenter, retrospective-cohort study involving 4770 infants diagnosed with ROP.
- Analysis of gestational age (GA) and birth weight (BW) data from infants screened between 2018 and 2023.
- Utilized receiver operating characteristic (ROC) curves to determine optimal predictive models for ROP screening.
Main Results:
- The study identified a mean GA of 29.67 weeks and mean BW of 1295.89 g among ROP infants.
- Proposed optimized screening criteria of GA ≤ 30 weeks and BW ≤ 1600 g.
- The optimized criteria achieved 99.4% sensitivity with an 18.0% reduction in screening requirements.
Conclusions:
- The demographic characteristics of infants requiring ROP treatment in China have shifted.
- Updating ROP screening guidelines with lower GA and BW thresholds is recommended.
- Optimized guidelines can enhance screening efficiency without compromising detection rates.
Background:
To analyze the demographic characteristics of retinopathy of prematurity (ROP) in China, attempting to propose optimized screening criteria and hopefully providing valuable information for future updates to the ROP guideline.
Methods:
A multicenter, retrospective-cohort study was conducted. The study included infants born between January 1, 2018, and July 31, 2023, who underwent ROP screening and were diagnosed with ROP at seven screening centers in China. Examinations were carried out in accordance with the ROP guidelines in 2014: infants with a gestational age (GA)<32 weeks and/or birth weight (BW)<2000 g, or infants who were suspected to be at risk of ROP. ROP treatment followed the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. We utilized receiver operating characteristic (ROC) curves to determine the optimal predictive model, and conducted internal validation as well as compared the model to current standards.
Results:
Among the 4770 infants diagnosed with ROP after fundus screening, 1330 (27.9%) infants received treatment. The mean GA at birth for all enrolled infants was 29.67 ± 2.45 weeks, with a mean BW of 1295.89 ± 403.64 g. This study proposed the optimization of guidelines to be ≤ 30 weeks of GA and ≤ 1600 g of BW, achieving a sensitivity of 99.4%, as high as the current standard, with an 18.0% reduction in screening requirements.
Conclusion:
Considering the decrease in both GA and BW among the population requiring ROP treatment in China, it is imperative to contemplate updating the ROP screening guideline.
