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Kirstin Tawse, Karen W Jeng, Caroline R Baumal; Practice Preferences in Treatment of Retinopathy of Prematurity (ROP). Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4318.
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To evaluate current practice patterns regarding therapy for retinopathy of prematurity (ROP) and characterize factors influencing clinical decisions.
A database of all ophthalmologists subspecializing in pediatrics and retina from the AAO, subspecialty societies and academic hospital information in the United States was compiled. An anonymous survey was emailed to obtain information regarding demographics, treatment practices and hypothetical clinical scenarios. Responses were analyzed using Fisher’s exact test.
From 2977 subspecialists identified, 647 (21.7%) completed the survey and 323 physicians self-reported as treating ROP in the last 5 years. ROP treaters consisted of 79% retina and 21% pediatric ophthalmology fellowship trained. 55% of ROP treaters perform intravitreal anti-VEGF injection for ROP with 78% utilizing bevacizumab and 22% using ranibizumab. The largest deterrent to anti-VEGF therapy from the options given was uncertainty regarding long term side effects reported by 65%. 18% responded that difficulty obtaining pediatric anesthesia and/or operating room access was an obstacle to laser treatment, while 64% reported there were no barriers to performing laser. For stage 3 ROP in zone 1 with plus disease, 54% favored initial anti-VEGF treatment while 42% preferred initial laser. Laser was the preferred initial treatment for 57% of respondents for stage 2 ROP in posterior zone 2 with plus, and for 81% of respondents for stage 3 ROP in mid zone 2 with plus. Geographic practice location was significantly associated with the use of anti-VEGF treatment of ROP (p=0.019); respondents from the South were most likely to elect to use anti-VEGF agents. Subspecialty training and length of time in practice were not significantly associated with treatment preferences.
Anti-VEGF injection is considered for initial therapy of posterior threshold ROP by over 50 percent of respondents in this survey. Geographic location was the only notable factor influencing treatment preferences. Concerns by clinicians regarding potential anti-VEGF side effects merit further investigation.
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