• ROP Classification Set to Undergo Update


    The International Classification of Retinopathy of Prematurity (ICROP) is undergoing its next iteration. ICROP3 Committee Chair Michael F. Chiang, MD, walked Pediatric Subspecialty Day attendees through a brief overview of ICROP’s history—and took a look at the reclassification work currently underway.

    Evolutionary steps. “ICROP developed over decades,” Dr. Chiang noted, from the years during which documentation was “purely descriptive” to the 2005 update including the the definition of and recommended treatment for pre-plus disease and AP (aggressive posterior) ROP.

    Need for standardization. Why is an update necessary? In part, because of subjectivity. As one research group noted, “We have found evidence of international variation in the diagnosis of treatment-requiring ROP.”1 In addition, as understanding of the disease has progressed, clinicians are now more likely to diagnose pre-plus and plus disease at earlier stages of disease severity, Dr. Chiang and his colleagues found.2 “Standard disease classification is essential for advancing clinical care and research,” Dr. Chiang said.

    Need to address recent advances. In addition, “improvements in neonatal care, anti-VEGF therapy, and imaging have led to an evolution in understanding of ROP pathophysiology and clinical management,” Dr. Chiang said. For instance, anti-VEGF treatment has brought issues of variable disease reactivation to the forefront.  

    What’s under consideration. The following changes are under consideration:

    • Inclusion of a new intermediate zone between zones I and II that would be known as “posterior zone II.”
    • Inclusion of zone nomenclature for “notch.”
    • Recognition that “plus disease” and “pre-plus” reflect a continuous spectrum of a vascular abnormality.
    • Definition of nomenclature representing ROP regression (either spontaneous or following laser or anti-VEGF treatment) and its sequelae.
    • Definition of nomenclature regarding ROP reactivation after treatment.
    • Inclusion of the understanding that AP-ROP may present in larger infants and appear different in babies from different parts of the world.

    Ultimate goal. With all proposed changes, the ultimate goal of ICROP3 is “to improve quality and standardization of ROP care worldwide—and to provide a foundation for improving clinical care and research in the future,” Dr. Chiang concluded. —Jean Shaw

    1 Fleck BW et al. Eye (Lond). 2018;32(1):74-80.

    2 Moleta C et al. Am J Ophthalmol. 2017;176:70-76.

    Watch from Pediatric Ophthalmology Subspecialty Day. If you are registered for AAO 2020 Virtual, you have access to the archived presentations on the virtual meeting platform until Feb. 15, 2021. Log in to the virtual meeting platform: Next, from the Lobby screen, select “Sessions” from the top navigation; click “Agenda” from the drop-down menu; and click on the “Friday” tab.  

    Financial disclosures. Dr. Chiang: Genentech: S; Inteleretina: O; National Eye Institute: S; National Science Foundation: S; Novartis: S.

    Disclosure key. C = Consultant/Advisor; E = Employee; L = Speakers bureau; O = Equity owner; P = Patents/Royalty; S = Grant support.

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