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  • Is It Time to Narrow the Criteria for ROP Screening?

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, December 2018

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    Current guidelines for detecting reti­nopathy of prematurity (ROP) in the United States include a wide range of birth weights and gestational ages and thus may entail unnecessary evaluation of infants who are at low risk for ROP. Quinn et al. examined data from the Postnatal Growth and ROP (G-ROP) study to discern the incidence, timing of onset, and early course of ROP. Of those who received serial ROP exams, 43.1% developed ROP, and 12.5% de­veloped severe ROP. Nearly all of those affected by severe ROP weighed less than 1,251 g at birth.

    This study was conducted at 29 hos­pitals in North America (from 2006-2011) and included 7,483 infants. Mean birth weight was 1,099 g. The most severe ROP in either eye was classified as none, mild, type 2, or type 1, accord­ing to criteria of the Early Treatment for ROP Study. Other documented data were postmenstrual age at ROP onset, stage of ROP, and treatment given.

    ROP occurred in 3,224 infants (43.1%), with type 1 disease developing in 459 (6.1%) and type 2 disease in 472 (6.3%). Roughly 98% of those with type 1 or 2 ROP had a birth weight <1,251 g. Of the babies born at ≤24 weeks’ gestation, severe ROP developed in 49.5%. Of those born after 30 weeks who weighed >1,501 g at birth, only four (0.75%) had severe ROP. Treat­ment was given to 514 infants (6.9%), in one or both eyes. Zone I disease was present in 147 infants (2%). Only about half the eyes (49.4%) had vasculariza­tion into zone III by 37 weeks’ post­menstrual age.

    Unlike other large studies, this research included all infants who were eligible for ROP screening. Although ROP was present in more than 40% of “at-risk” premature infants, most cases did not require treatment. The lower-risk profile noted for larger babies supports efforts to improve the specificity of risk assessment and raise the possibility of a revision of the crite­ria that warrant examination for ROP. (Also see related commentary by Amy K. Hutchinson, MD, in the same issue.)

    The original article can be found here.