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Long-Term Retinopathy of Prematurity Outcomes with Mandated Screening Interval and Grader Continuity at a High-Volume
Cindy S Zhao1, Arthur R Brant1, Sarthak V Shah1
1From the Horngren Family Vitreoretinal Center (C.Z., A.B., S.S., E.K., M.G., D.M.), Byers Eye Institute, Dept. of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, USA.
Insights
A 12-year study of retinopathy of prematurity (ROP) screening using binocular indirect ophthalmoscopy (BIO) found that grader continuity and mandated weekly screening led to excellent outcomes, with no infants experiencing blindness from ROP.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- Effective screening protocols are crucial for early detection and intervention.
- Quaternary teaching hospitals and referral centers play a vital role in managing ROP.
Purpose of the Study:
- To analyze ROP screening patterns and treatment rates at a major referral center.
- To evaluate the impact of mandated screening intervals and grader continuity on ROP outcomes.
- To assess the incidence of treatment-warranted ROP and retinal detachment.
Main Methods:
- Retrospective cohort study of 1,860 infants undergoing ROP screening from 2013-2024.
- Utilized a binocular indirect ophthalmoscopy (BIO) screening model with continuous graders and mandated intervals.
- Compared outcomes based on gestational age, birth weight, inborn/outborn status, and screener continuity.
Main Results:
- 15,798 examinations were performed; 88.8% of patients had consistent screening by a single grader.
- Outborn infants had significantly lower gestational age and birth weight, and higher treatment rates (9.0% vs 4.6%).
- No infants developed retinal detachment; 5.4% required treatment for ROP.
Conclusions:
- A BIO ROP screening model with grader continuity and mandated weekly intervals demonstrated excellent outcomes over 12 years.
- No cases of ROP-induced blindness were observed within this model.
- Grader continuity may be a key factor in achieving lower intervention rates and preventing severe ROP complications.
Objective:
To summarize screening patterns and treatment rates from a quaternary teaching hospital and regional retinopathy of prematurity (ROP) referral center, highlighting mandated screening interval protocols and grader continuity.
Design:
Retrospective cohort study.
Methods, Intervention, Or Testing:
A retrospective review and descriptive analysis of all patients who underwent inpatient ROP screening within a quaternary teaching hospital from 2013 to 2024. The screening model employed here used continuous screening by assigned graders without handoff and mandated screening interval with binocular indirect ophthalmoscopy (BIO). Variables compared included estimated gestational age, birth weight, weight at each screening, inborn vs outborn status, screening date and intervals, treatment, risk category, and location. ANOVA testing was performed for multiple comparisons, and two-sample T-testing was performed for binary comparisons.
Main Outcome Measures:
Incidence of Treatment-Warranted ROP and rate of retinal detachment.
Results:
Within the study period, 15,798 examinations occurred for 1,860 patients. 1,651 (88.8%) patients were only examined by one of four screeners. For each of the four screeners, between 98.1% and 99.3% of examination intervals were weekly or more often. Patients came from 34 different hospitals and 334 (18.0%) were outborn. Outborn (vs inborn) patients had significantly (P < .005) younger mean (±SD) EGA (27.8 ± 3.0 weeks vs 29.0 ± 3.0 weeks) and lower mean (±SD) birthweight (1066.9 ± 408 grams vs 1181.4 ± 416 grams). The screener who accounted for the most treatments also saw more high risk (nano- and micro-premature) infants, with a 19.4% treatment rate of these infants. Volume increased over time, but no seasonal trends were identified (P = .51). A hundred (5.4%) required treatment, more often those who were outborn (4.6% inborn vs 9.0% outborn, P = .002). None developed a retinal detachment.
Conclusion:
Twelve years of data from a BIO ROP screening model which relies on single screeners for continuity of care and mandated weekly screening demonstrated excellent outcomes. No infants succumbed to blindness from ROP within this screening model. Grader continuity may have contributed to lower intervention rates.
