Retinopathy of prematurity screening and risk mitigation during the COVID-19 pandemic

Abstract

Background The coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted the delivery of healthcare. Although most nonurgent ophthalmology visits at Boston Children’s Hospital were canceled, premature infants at risk for retinopathy of prematurity (ROP) still required timely, in-person care during the initial 3-month period of the infection surge in Massachusetts. The purpose of the current study was to report our protocols for mitigating risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between infants and eye care providers and to compare examination rates and results with the same 3-month period in 2019. Methods During the infection surge, we added new infection control measures and strengthened existing ones. Additional personal protective equipment was used, and the number of ophthalmologists rotating in the three high-capacity NICUs we service was limited. Results More infants required ROP examinations during the study period in 2020 than in the same period in 2019, but fewer examinations were performed. There were no cases of missed progression to severe ROP during this time and no known transmission of SARS-CoV-2 between ROP patients and ophthalmology staff. Conclusions Overall, effective ROP care was safely provided during the COVID-19 pandemic, and contact with this vulnerable population was minimized.

Evaluation of a revised care plan for babies with retinopathy of prematurity during SARS-CoV-2 pandemic in India

“…[ 13 ] This could be the result of several factors and include delayed presentations, a tighter screening aimed at detecting babies with ROP or treatment requiring ROP, reducing the number of follow- up of babies with fundus changes of less concern (such as immature retina with no ROP), teleconsultation of ROP images in some, and telephonic consultation of referring ophthalmologists. [ 16 ] In this reported period, more babies were treated with intravitreal anti-VEGF injections than laser, even for babies suitable for both modalities compared to other reports [ Table 5 ]. The reasons could be the increased preference by the treating doctors for a shorter procedure and availability of a network of ROP care in some peripheral districts with scope for post-injection follow-up care.…”

Challenge Accepted: Retinopathy of Prematurity (ROP) During COVID-19

“…For safe, secure, effective, and compatible ROP screening and management, the following are required: optimal use of technology, measures to minimize the risk of transmission of infections, and reduce multiple screening for lower-risk babies by keeping an eye on parameters like weight gain per day, kangaroo mother care (KMC), urine output and other developmental milestones, which can be reported by parents. The use of risk-stratification algorithms should be considered to reduce examinations for low-risk infants [ 8 ]. Concentrating on high-risk babies and timely intervention is the key point for optimal screening and management in pandemic-like situations.…”

COVID-19 Related Eye Manifestations: A Narrative Review

“…If treatment is needed, retinal laser photocoagulation should be used instead of intravitreal anti-VEGF injection (due to less need for frequent follow-up after surgery) except in special cases. Finally, the need for tele-medicine and retinal imaging facilities such as RetCam, especially in remote areas, seems more reasonable (69,70). Intravitreal injection is a well-known procedure in various chorioretinal disorders and is probably the most common procedure performed in ophthalmology (71).…”