No abstract

This statement revises a previous statement on screening of preterm infants for retinopathy of prematurity (ROP) that was published in 2006. ROP is a pathologic process that occurs only in immature retinal tissue and can progress to a tractional retinal detachment, which can result in functional or complete blindness. Use of peripheral retinal ablative therapy by using laser photocoagulation for nearly 2 decades has resulted in a high probability of markedly decreasing the incidence of this poor visual outcome, but the sequential nature of ROP creates a requirement that at-risk preterm infants be examined at proper times and intervals to detect the changes of ROP before they become permanently destructive. This statement presents the attributes on which an effective program for detecting and treating ROP could be based, including the timing of initial examination and subsequent reexamination intervals. Pediatrics 2013;131:189-195

ROP remains a common important problem among infants with birth weights of <1251 g. The incidence of ROP, time of onset, rate of progression, and time of onset of prethreshold disease have changed little since the CRYO-ROP natural-history study.

No abstract

No abstract

No abstract

Objective-To compare visual acuity at 6 years of age in eyes that received early treatment for high-risk prethreshold retinopathy of prematurity (ROP) with conventionally-managed eyes.Methods-Infants with symmetrical, high-risk prethreshold ROP (N=317) had one eye randomized to earlier treatment at high-risk prethreshold disease and the other eye managed conventionally, treated if ROP progressed to threshold severity. For asymmetric cases (N=84), the high-risk prethreshold eye was randomized to either early treatment or conventional management.Main Outcome Measures-ETDRS visual acuity measured at 6 years of age by masked testers. Retinal structure was assessed as a secondary outcome.Results-Analysis of all subjects with high-risk prethreshold ROP showed no statistically significant benefit for early treatment (24.6% v. 29.0% unfavorable outcome, P=0.15). Analysis of 6-year visual acuity results according to the Type 1 and 2 clinical algorithm showed a benefit for Type 1 eyes (25.1% v. 32.8%, P=0.02) treated early, but not Type 2 eyes (23.6% v. 19.4%, P=0.37). Early treated eyes showed a significantly better structural outcome compared with conventionally managed eyes (8.9% v. 15.2% unfavorable outcome, P<0.001), with no greater risk of ocular complications. Conclusion-Early treatment forType 1 high-risk prethreshold eyes improved visual acuity outcomes at 6 years of age. Early treatment for Type 2 high-risk prethreshold eyes did not.Application to Clinical Practice-Type 1 eyes, not Type 2 eyes should be treated early. These results are particularly important considering that 52 % of Type 2 high-risk prethreshold eyes underwent regression of ROP without requiring treatment.

Severity of neonatal ROP seems to be a marker for functional disability at age 5. 5 years among very low birth weight survivors. High rates of functional limitations in multiple domains occur in children who had threshold ROP, particularly if they have unfavorable visual acuity.