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Swati Agarwal; Variations in Practice Patterns in Retinopathy of Prematurity (ROP) care: A Web-based Survey. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5523.
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A distinct variation exists amongst physicians in providing ROP care to premature infants requiring treatment and those not requiring treatment, irrespective of the American Academy of Pediatric (AAP) published guidelines. With this web-based survey, we studied the preferences and trends in practice patterns in infants treated with and without anti-VEGF/laser therapy for ROP
A web-based survey was administered to members of AAPOS, ASRS and WSPOS. 267 U.S. and international physicians participated. The survey included questions regarding competency in lasers and intravitreal injections (IV), preferences in treatment with anti-VEGF bevacizumab (IVB), laser or dual therapy for type 1 ROP, frequency of follow-up, postmenstrual age (PMA) of conclusion of retinal examination, and incidence of late recurrence or retinal detachment.
73% pediatric ophthalmologists reported incompetency in providing IV injections and 54.1% in providing laser. In infants with persistent avascular retina without pre-threshold disease or worse ROP, 54.2% continued examination >50 weeks PMA, 23.3% discontinued at 50 weeks PMA, 3.2% preferred prophylactic laser and 5.1% fluorescein angiography and laser prior to concluding exams. 46.3% physicians preferred IVB as primary monotherapy, 37.3% laser, and 16.4% both IVB and laser in type 1 ROP. Of those who preferred IVB monotherapy, 20.4% concluded examination at ≤55 weeks PMA, whereas 79.6% continued evaluation >55 weeks PMA (range = 60 to ≥80 weeks). Of those who preferred both IVB and laser, 50.6% concluded examination at ≤ 50 weeks PMA, whereas 49.4% continued >50 weeks (range = 55 to ≥80 weeks). 15.5 % reported recurrence or late stage retinal detachment with IVB monotherapy and 8.8% with dual therapy.
Treatment preferences and conclusion of examination in ROP care varies considerably without and with treatment. Though a longer follow-up is recommended with IVB, our survey reveals extended examinations beyond 50 weeks PMA in infants with persistent avascular retina requiring no treatment and even in laser treated subgroup. This survey highlights low competency in providing treatment by pediatric ophthalmologists, with distinctly variable patterns in ROP care. Further multicenter observational trials are necessary to assess risk/benefits of extended follow-ups, doses and long-term effects of IVB and the role of prophylactic laser in ROP care.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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