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Current problems in the management of ROP
1Hammersmith Hospital, London, England.
Insights
British screening for retinopathy of prematurity (ROP) is widely implemented, with 97% of units having a policy. However, practices vary significantly, and challenges remain in screening and treatment delivery for at-risk neonates.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Established guidelines exist for retinopathy of prematurity (ROP) screening and treatment.
- Implementation and delivery of ROP care present practical challenges.
Purpose of the Study:
- To audit current ROP screening and treatment practices in British specialized neonatal units.
- To identify practical issues encountered in ROP screening and treatment delivery.
Main Methods:
- A national survey of 118 specialized units caring for at-risk neonates in Britain.
- Data collection on screening policies, referral rates, treatment modalities, and healthcare professional opinions.
Main Results:
- 97% of units have an ROP screening policy, with consultant ophthalmologists performing 86% of screenings.
- 23% of units referred infants to specialized treatment centers; approximately 3% of screened infants received treatment.
- Cryotherapy (85%) and laser photocoagulation (51%) were common treatments, with 36% using both. Less than 25% of neonatologists desired ROP screening training.
Conclusions:
- ROP screening guidelines are largely implemented in Britain, but significant practice variations exist.
- Practical challenges in ROP screening and treatment require further discussion and potential solutions.
- The survey highlights the need for standardized approaches and potentially broader training for ROP management.
Abstract:
Guidelines for screening for retinopathy of prematurity (ROP) and indications for treatment are well established, but implementation of screening and delivery of treatment may be problematical. We have performed a national survey of 118 specialised units dealing with at risk neonates to audit current practice in Britain and to identify practical problems with screening and with treatment. A screening policy for neonates at risk is in practice at 97% of units, performed by consultant ophthalmologists in 86% of centres. Units referred to specialised treatment centres in 23% of cases. An average of 54 infants at risk of ROP were screened by each of 118 units throughout Britain in 1993, and approximately 3% of these infants underwent treatment for ROP. Cryotherapy was used for treatment in 85% of units, laser photocoagulation in 51% and both treatment modalities were used in 36% of units. Less than 1/4 of the neonatologists polled were of the opinion that they should be trained to screen for ROP themselves. These results show that the screening guidelines have been successfully implemented in Britain, but demonstrate a wide variation in practice. Problems with screening and treatment are discussed.