Validation of Model to Reduce ROP Screening Burden

Journal Highlights

American Journal of Ophthalmology, January 2024

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The e-ROP study was designed to assess the validity, reliability, feasibility, and cost-effectiveness of a telemedicine system to detect at-risk eyes that require examination by an ophthalmologist adept at treating retinopathy of prematurity (ROP). The researchers concluded that among infants born at or after 27 weeks’ gestational age who weigh more than 750 g at birth, there is little value in continuing ROP surveillance beyond discharge if retinopathy had not been detected by 37 weeks’ gestational age. Subsequently, Pruett et al. tested and validated this potential guideline in a multicenter population of infants that was more than five times that of the e-ROP study.

For this work, the authors reviewed the health records of all infants treated for ROP from February 2004 through April 2022 at one of six medical centers in the mid-southern region of the United States. Data for gestational age, birth weight, and ROP status at 37 weeks’ gestational age were documented and analyzed to determine whether any treated infant would have been “missed” by the screening criteria derived from the e-ROP study.

Altogether, 6,729 infants were screened for ROP, 298 (4.43%) of whom were treated. In 10 infants who required treatment, the first evidence of ROP developed after 37 weeks’ gestational age. However, only one infant born at or after 27 weeks’ gestational age with a birth weight >750 g was treated later for ROP. This infant was a girl born at 27 6/7 weeks who weighed 825 g. Her birth was complicated by twin gestation, breech position, and maternal obesity and chronic hypertension. Her first ROP exam occurred at 32 5/7 weeks’ gestational age, after transfer from a remote hospital with limited care. During the exam, bilateral immature retina was identified (zone 2, stage 3, preplus ROP). Vascularity had reached zone 3 by four weeks later. Even though her condition did not represent “treatment-warranted ROP,” treatment was begun to safeguard
against the family’s limited access to proper care.

These results support the value of birth weight and gestational age in determining the need for ROP surveillance, said the authors. “The validation of these models has been important in refining the standard approach to ROP screening and risk assessment,” they added. However, they cautioned that the retrospective nature of their study, combined with its restriction to a specific geographic area, may limit applicability of the findings to other regions, especially developing countries that have different neonatology practices.

The original article can be found here.