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Screening for retinopathy of prematurity in South Africa: are those developing severe ROP screened on time? Data from
Tshilidzi van der Lecq1, Natasha Rhoda2, Esmè Jordaan3,4
1Department of Surgery, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa.
Insights
Most preterm infants in South Africa receive timely retinopathy of prematurity (ROP) screening, preventing severe disease. Recommendations suggest initiating ROP screening based on postnatal age (PNA) alone to improve adherence.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in preterm infants.
- South African (SA) guidelines exist for timely ROP screening to prevent severe outcomes.
- Early detection and intervention are crucial for managing ROP.
Purpose of the Study:
- To evaluate the timeliness of ROP screening initiation in South African preterm infants.
- To assess if screening occurs before the development of stage 3 or type 1 ROP.
- To inform ROP screening strategies in resource-limited settings.
Main Methods:
- A prospective study was conducted in five Cape Town neonatal units from May 2022 to January 2023.
- Data from 696 preterm infants (<1250g birth weight or <32 weeks gestational age) were collected from the ROPSA register.
- Postnatal age (PNA) and postmenstrual age (PMA) at first screening were key data points.
Main Results:
- 78.9% of infants had ROP screening initiated on time per SA guidelines.
- No infants screened on time developed stage 3 or type 1 ROP at initial screening.
- 45.8% of infants were screened based on PNA only; follow-up attendance was poor for those screened once.
Conclusions:
- Timely ROP screening, initiated before severe disease onset, is achievable in most cases.
- Recommends initiating ROP screening using PNA alone (4-6 weeks or before discharge) due to limited early ultrasound availability.
- Study limitations include a low proportion of infants with severe ROP, potentially affecting generalizability to other SA regions.
Background/Aims:
To determine whether retinopathy of prematurity (ROP) screening is initiated on time according to current South African (SA) guidelines, that is, before the onset of stage 3 and type 1 ROP.
Methods:
A prospective study of preterm infants screened at five neonatal units between 1 May 2022 and 31 January 2023 in Cape Town, SA. Data on all infants screened with a birth weight <1250 g or gestational age (GA) <32 weeks were extracted from the ROP South African (ROPSA) register, including postnatal age (PNA) and postmenstrual age (PMA) at first screening.
Results:
A total of 696 infants were included, 58.9% (n=410) of whom had an early ultrasound (EUS) for GA estimation. Overall, 220 (31.6%) infants developed ROP, 20 (2.9%) had stage 3 or type 1 and 7 (1.0%) required treatment. Screening was initiated on time according to SA criteria in 549 (78.9%) infants, none of whom had stage 3 or type 1 ROP at first screening. Stage 3 and type 1 ROP were first detected at PNA and PMA of 6.3 and 33.1 and 8.9 and 35.9 weeks, respectively. Most infants (319, 45.8%) were screened according to PNA only, and 78.9% of the 185 infants screened only once did not attend subsequent examinations.
Conclusion:
Screening started on time in most infants and prior to the development of severe ROP. Due to the limited availability of EUS in our region and to promote complete screening, we recommend that screening be initiated using PNA alone at 4-6 weeks or prior to discharge, whichever is earliest. The low proportion of infants with stage 3 and type 1 ROP is a limitation in our study. Therefore, recommendations may not be generalisable to South African regions where neonatal care results in a higher proportion of infants developing type 1 ROP.
