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Variations in prevalence of retinopathy of prematurity (ROP) and completeness of screening in five units within a
Tshilidzi Van der Lecq1, Gerd Holmström2, Esmè Jordaan3,4
1Department of Surgery, Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. Tshilidzi.vanderlecq@uct.ac.za.
Insights
Many infants in South Africa miss crucial retinopathy of prematurity (ROP) screenings, leading to delayed treatment for this cause of childhood blindness. Improving screening completeness is vital for early ROP detection and prevention.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness.
- Screening frequency and completion rates for ROP vary significantly across South Africa.
- A substantial number of infants in South Africa do not complete their recommended ROP screening.
Purpose of the Study:
- To compare the prevalence of ROP and the completeness of screening across different units in Cape Town, South Africa.
- To identify the proportion of infants with ROP, including severe stages, who did not complete screening.
Main Methods:
- A prospective study involving infants screened for ROP in five Cape Town units from February 2023 to April 2024.
- Data extraction from the Retinopathy of Prematurity South African (ROPSA) register for infants meeting specific gestational age and birth weight criteria.
Main Results:
- Screening was initiated in 933 infants, with only 50.2% completing it; completeness varied from 36.8% to 74.6% across units.
- ROP prevalence ranged from 16.1% to 71.2% among those starting screening and 13.1% to 64.3% among those completing it.
- Of 315 infants diagnosed with ROP, 56.8% had incomplete screening, including 58.8% with stage 3 ROP.
Conclusions:
- Significant variations in ROP screening completeness and prevalence exist among South African units.
- A high percentage of infants with ROP, including stage 3, do not complete screening, highlighting a critical gap in care.
- Implementing measures to enhance screening completeness is essential for timely ROP detection and treatment, with the ROPSA register aiding monitoring.
Background:
Retinopathy of prematurity (ROP) is an avoidable cause of childhood blindness. Effective ROP screening enables the detection of cases requiring treatment, but the frequency of ROP varies in units across South Africa (SA). Recent evidence suggests that a high proportion of infants in SA do not complete screening. A comparison of ROP prevalence and completeness of screening in units within the same region has yet to be described.
Methods:
A prospective study of infants screened for ROP at five units was conducted between 1 February 2023 and 30 April 2024 in Cape Town, SA. Data were extracted for infants with birth weight <1250 grams or gestational age <32 weeks from the Retinopathy of Prematurity South African (ROPSA) register.
Results:
Screening was initiated in 933 infants and completed in 468 (50.2%). Completeness of screening varied in the units from 36.8% to 74.6%. The prevalence of ROP among infants who started screening (16.1%-71.2%), completed screening (13.1%-64.3%), and those incompletely screened (25.0%-79.2%) also varied in the units. Among those diagnosed with ROP (n = 315), 179 (56.8%) had incomplete screening, including 30 (n = 51, 58.8%) infants with stage 3 ROP.
Conclusion:
Completeness of screening and ROP prevalence varied widely in the units. Of concern is the high proportion of infants with ROP, including stage 3 ROP, who do not complete screening. Measures to increase completeness of screening are needed to improve the detection of cases requiring treatment. The ROPSA register will allow these improvements to be monitored over time.
