The Cryotherapy for Retinopathy of Prematurity Cooperative Group determined that signs of ROP were present in 66% of infants with a birth weight of 1250 g or less and in 82% of infants with a birth weight of less than 1000 g. Recommendations for the screening examination of premature infants at risk for ROP have been issued in a joint statement of the American Academy of Pediatrics, Section on Ophthalmology; the American Association for Pediatric Ophthalmology and Strabismus; and the American Academy of Ophthalmology (available at www.aao.org/clinical-statement/screening-examination-of-premature-infants-retinop). Screening should consist of a dilated fundus examination using binocular indirect ophthalmoscopy. Alternatively, there are telemedicine (photographic) screening approaches that can substitute for the indirect ophthalmoscopic examination (see the section Fundus Photographic Screening of ROP).
One caveat of paramount importance to recognize is that screening criteria and risk factors developed in one country do not necessarily apply in another country, especially if the level or quality of available medical or perinatal care is not comparable. For example, in some countries ROP is seen in babies with a higher birth weight than in the United States; thus, screening criteria need to be developed that reflect local experiences.
All infants with a birth weight of less than 1500 g or a gestational age of 30 weeks or less should be screened. In addition, infants with a birth weight between 1500 g and 2000 g or a gestational age greater than 30 weeks, with an unstable clinical course, and who are believed to be at high risk by their attending pediatricians or neonatologists should be screened. The first examination should generally be performed between 4 and 6 weeks of postnatal age or, alternatively, between 31 and 33 weeks’ postconceptional or postmenstrual age, whichever is later.
Systemic IGF-1 levels and weight gain are also associated with ROP risk. Taken together, the rate of weight gain and IGF-1 levels are more predictive of ROP development than is either value alone. A newer model—the weight, IGF-1, neonatal ROP (WINROP) algorithm—is being assessed for more targeted screening efforts, replacing the conventional screening criteria. In some studies, this model has been 100% sensitive in detecting at-risk infants while identifying as many as 90% of infants that do not need screening. The WINROP model has led to interest in developing other, preferably simpler, algorithms to identify infants at risk for ROP who will require screening.
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.