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Severe ROP rate and assessment of the burden of ROP screening at a single tertiary care public hospital in Pakistan
Muhammad Moin1, Lubna Siddiq Mian2, Miranda Martinez-Hussain3
1King Edward Medical University, College of Ophthalmology and Allied Vision Sciences (COAVS), Mayo Hospital, Lahore, Pakistan. mmoin7@gmail.com.
Insights
The third epidemic of Retinopathy of Prematurity (ROP) requires urgent screening and treatment scale-up in Pakistan. Effective screening programs are achievable in public hospitals, with initial guidelines recommending screening for infants with gestational age ≤ 35 weeks.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of Prematurity (ROP) poses a significant threat to preterm infants.
- Assessing the incidence of severe ROP and the examination burden is crucial for resource allocation.
Purpose of the Study:
- To evaluate the rate of severe ROP and the examination workload in preterm infants requiring screening.
- To inform the development of effective ROP screening programs in resource-limited settings.
Main Methods:
- Prospective study of preterm infants (GA ≤ 35 weeks or BW ≤ 2000g) at Lahore General Hospital (2015-2021).
- Dilated fundus examinations were performed, recording ROP levels and number of screenings.
- Infant outcomes including mortality and follow-up compliance were documented.
Main Results:
- Out of 3,521 eligible infants, 46.7% were screened. Severe ROP (Type 1, Stages 4-5) occurred in 9.7% of screened infants.
- Mortality (42.2%) and lack of follow-up (11.2%) were significant reasons for infants not being screened.
- Average examinations per patient were 2.4, with most infants requiring outpatient screening post-discharge.
Conclusions:
- Pakistan is experiencing a third ROP epidemic, necessitating immediate screening and treatment expansion.
- Effective ROP screening is feasible in public hospitals with existing resources and a GA ≤ 35 weeks protocol.
- Integrating outpatient care and leveraging experienced ophthalmologists are key to successful ROP screening programs.
Background:
To assess the rate of severe ROP and the burden of examining preterm infants requiring ROP screening.
Methods:
A prospective study of all inborn preterm infants eligible for ROP screening admitted to Lahore General Hospital (LGH) between 2015 and 2021 with a gestational age (GA) of ≤ 35 weeks or a birthweight (BW) of ≤ 2000 g. All infants had a dilated fundus exam, and the number of examinations and level of ROP were recorded.
Results:
3,521 infants met the screening criteria, 1,641 (46.7%) of whom were screened at least once. Among the 1880 (53.3%) not screened, 42.2% of eligible babies died and 11.2% were discharged and did not return for screening. Rates of any ROP, Type 1 ROP and more advanced ROP (stages 4 and 5) were 32.2%, 9.7% and 0.7%, respectively. Among the 170 infants with Type 1 and more advanced ROP (i.e. severe ROP) 45% had a GA of 30-35 weeks, 18.8% had a GA of ≥ 32 weeks, and 25% had a BW of > 1500 g. The average inpatient stay was 10.7 days, and nearly all infants required outpatient screening. The total number of examinations was 4,007 with an average of 2.4 per patient.
Discussion:
The third epidemic of ROP has arrived in Pakistan. There is an urgent need to scale up screening and treatment. Effective screening programs in public hospitals can be established with current resources. Initial screening guidelines need to include at least a GA of ≤ 35 weeks. Most infants will require outpatient screening after discharge. Estimates of screening and treatment burden can be made from these data for similar institutions initiating ROP screening programs.
Conclusions:
Effective screening is achievable in public hospitals using existing resources, especially with committed staff. The < 35 weeks GA protocol is essential, and outpatient care must be integrated into program planning. Limitations include single-site data and lack of retinal imaging, but all examinations were conducted by experienced ophthalmologists.
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