Prevention and Risk Factors
As ROP became a clinically distinct and recognized entity in the 1950s, supplemental oxygen administration was implicated as a major causative factor. After substantial reductions in oxygen use in neonatal intensive care units, the incidence of ROP decreased dramatically. However, many of the infants incurred adverse neurologic outcomes as an unintended consequence of that oxygen restriction, and infant death rates rose. Once oxygen was again used more liberally, neurologic outcomes and survival improved, with the consequence of a resurgence of ROP.
Preventing ROP begins with preventing prematurity through optimal prenatal, perinatal, and postnatal care. Avoiding extremely low birth weight and short gestational ages may be the most important factors in prevention. There is mounting evidence that the postnatal clinical course alters risk as well; that is, very sick premature infants are at greater risk of developing ROP. Specific factors shown to increase the risk of ROP are sepsis, blood transfusion, and a slow rate of postnatal weight gain.
Diet has been recognized as an additional risk factor. Several studies are currently under way to assess nutritional interventions for reducing the risk of ROP; one such intervention is addition of the sugar inositol to the neonate’s diet (formula) or parenteral nutrition.
BOOST II United Kingdom Collaborative Group; BOOST II Australia Collaborative Group; BOOST II New Zealand Collaborative Group, Stenson BJ, Tarnow-Mordi WO, Darlow BA, et al. Oxygen saturation and outcomes in preterm infants. N Engl J Med. 2013;368(22): 2094–2104.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.