Retinopathy of prematurity in practice. I: screening for threshold disease

Abstract

Aims To review an 11-year period of screening for retinopathy of prematurity (ROP) in the north of England by a single ophthalmologist. To identify the gestational ages and birth weights of babies reaching different stages of ROP. To investigate the workload involved in screening to detect threshold ROP, and that the practical outcomes had narrower inclusion criteria for screening. To identify babies treated for threshold disease. Methods During the period August 1987-October 1998, babies were screened according to the national guidelines and the results were prospectively entered onto a computerised database. These data were then systematically reviewed. Results Data were available for 484 babies: 203 (41.9%) developed any ROP, 46 (9.5%) reached stage 3 ROP, and 25 (5.2%) reached threshold and were treated. Data on 425 babies showed them to require an average of 2.3 screening examinations per baby. It took an average of 39 screening examinations to detect one case of threshold ROP. The more premature and lighter birth weight babies required the most examinations. Therefore, restricting the inclusion criteria for screening would only have reduced the total number of screenings modestly and could have allowed us to miss two of our threshold cases who were both of 30 weeks gestational age and 41400 g birth weight.Conclusions Screening is time consuming but worthwhile in view of the benefits of treatment. As applied to babies in the north of England, the current national screening criteria are satisfactory. The results of treatment of the babies identified in this study are presented in the accompanying paper.

Do current retinopathy of prematurity screening guidelines miss the early development of pre-threshold type 1 ROP in small for gestational age neonates?

“…7 It has been well documented that babies born SGA have an increased risk of developing severe ROP [8][9][10] and this is confirmed in our small series, with 18.2% of the SGA babies requiring treatment for ROP compared to 12.8% of the others. In addition, however, this study indicates that babies who are SGA may develop pre-threshold type 1 ROP 3-4 weeks earlier in the post-natal period.…”

Retinopathy of prematurity in practice. II: long-term results following treatment for threshold disease

“…19 In all, 25 infants with disease at or beyond threshold disease were identified and underwent treatment using cryotherapy or laser photocoagulation. A further 10 infants with similar disease were referred from peripheral units for treatment.…”

“…The treatment of threshold ROP would certainly seem to justify the investment of resources in ROP screening detailed in the accompanying paper. 19 It is encouraging to see that the favourable results of the multicentre trial can be achieved in everyday clinical practice, even when including the 'learning curve' of the surgeon involved.…”

“…19 The parents of the 29 surviving patients were contacted to participate in the prospective study. A total of 21 (72.4%) children (Group 1) attended a special clinic to assess visual acuity, motility, cycloplegic refraction and fundoscopy.…”

Characteristics of Infants With Severe Retinopathy of Prematurity in Countries With Low, Moderate, and High Levels of Development: Implications for Screening Programs

“…However, studies from the United Kingdom show that more mature infants need fewer examinations, and the majority of infants with GA Ͼ32 weeks are likely to need only 1 examination. 19 Broadening the criterion, therefore, may not increase the workload as much as might be anticipated. Another issue is that more mature infants are likely to be discharged before the first examination, making implementation of a screening program challenging.…”