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Screening for retinopathy of prematurity (ROP) in South Africa: data from a newly established prospective regional
Tshilidzi van der Lecq1, Natasha Rhoda2, Esmè Jordaan3,4
1Department of Surgery, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa Tshilidzi.vanderlecq@uct.ac.za.
Insights
Low screening coverage for retinopathy of prematurity (ROP) in South Africa may bias ROP frequency data. Improving screening rates is crucial for accurate ROP monitoring and guideline revision.
Area of Science:
- Neonatal care
- Ophthalmology
- Public health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Population-based registers are essential for monitoring ROP screening programs and improving outcomes.
- The ROP South African (ROPSA) register was established to assess ROP frequency and screening coverage.
Purpose of the Study:
- To determine the frequency of ROP and the coverage of ROP screening in a South African cohort.
- To evaluate the effectiveness of current ROP screening programs.
- To inform revisions of national ROP screening guidelines.
Main Methods:
- Prospective data collection from infants born between May 2022 and January 2023 at five Cape Town NICUs.
- Inclusion criteria: gestational age <32 weeks or birth weight <1250g.
- Data extracted from the ROPSA register for analysis.
Main Results:
- 696 of 1154 (60.3%) eligible infants were screened; 45.7% had incomplete screening.
- ROP was detected in 31.6% of screened infants; 1.0% required treatment.
- Infants with incomplete screening had significantly lower gestational age and birth weight.
Conclusions:
- Low screening coverage and high rates of incomplete screening may bias ROP frequency data from the ROPSA register.
- Further investigation into reasons for low screening coverage is needed.
- Interventions to improve screening are necessary, and the ROPSA register can monitor their impact.
Objective:
Retinopathy of prematurity (ROP) registers enable population-based studies to monitor ROP screening programmes to improve their effectiveness. The aim of this study was to determine the frequency of ROP and the coverage of screening in a South African cohort using a prospective ROP South African (ROPSA) register.
Methods And Analysis:
Infants born from 1 May 2022 to 31 January 2023 and screened prospectively for ROP at five neonatal intensive care units in Cape Town were included. The screening criteria were a gestational age (GA) <32 weeks or birth weight (BW) <1250 g. Data were extracted from the ROPSA register and analysed.
Results:
696 of 1154 (60.3%) eligible infants were screened, almost half of whom (45.7%) did not complete screening. ROP was detected in 220 infants (31.6%, 95% CI 28.3% to 35.3%), 7 (1.0%) of whom required treatment. Infants with incomplete screening had a lower mean GA than those who completed screening; 28.7 (SD 1.6, range 25-33) and 29.1 (SD 1.7, range 24-36) weeks, respectively (p=0.004) and a lower mean BW; 1048 (SD 203, range 650-1690) g and 1108.5 (SD 227, range 640-1840) g, respectively (p<0.001).
Conclusions:
Data from the ROPSA register on the frequency of any ROP and treatment-requiring ROP may be biased due to low screening coverage and high incomplete screening. Reasons need to be explored and corrective interventions initiated. The ROPSA register will enable the impact of these interventions to be monitored. The findings of this study will contribute to the ongoing revision of South African national ROP screening guidelines.
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