Retinopathy of prematurity: A global review of screening guidelines

We assess the presence and specifics of national retinopathy of prematurity (ROP) screening guidelines in all 195 countries to understand variances, identify gaps, and guide global practice. PubMed, government websites, and World Health Organization articles were searched for national guidelines in any language. Documents published between 1998 and 2024 were included. National ROP screening guidelines were found for only 65 countries (33%). Screening cutoffs varied greatly for gestational age (30-37 weeks) and birth weight (1250-2500 g). Higher income countries were more likely to have guidelines (χ² = 19.4, p < 0.001). Thirty-two of the 65 countries (49%) had guidelines for termination of acute phase screening, 26 countries (40%) had post-acute phase screening follow-up guidelines, and 37 countries (57%) had treatment guidelines. No countries had risk-tailored approaches to screening. Most countries lack national ROP guidelines, and many have variations for screening criteria, follow-up, and treatment. There is a significant need for global initiatives and collaboration to address major policy gaps, particularly in Africa, and ultimately improve ROP outcomes.