Optimization of Ophthalmic Follow–Up of Pre–Term Babies Who Had Undergone Screening for Retinopathy of Prematurity

Abstract

Abstract: : Purpose: To assess and optimize the follow–up of pre–term children, who had screening for Retinopathy of Prematurity (ROP) in a District General Hospital. Methods: A retrospective review of all babies born between 1996 and 1999 fulfilling the national ROP screening criteria, was undertaken. The same cohort was traced at preschool and at 5 years of age. The criteria to pass the preschool orthoptist community assessment were uniocular vision of 6/9 or better (with Single Sheridan Gardner), no manifest deviation or significant phoria, full ocular motility, evidence of stereoacuity (tested with frisby or lang stereotest) and the ability to overcome a 20 prism dioptre lens. To pass the 5 year school check, the children had to attain a vision of 6/6 or better on Snellen chart. Cases without both details of the preschool and 5 year review were excluded from this study. A detailed analysis of the medical notes of those fulfilling the criteria of this study was performed. Results: Ninety two children satisfied the inclusion criteria. Of these 53.26% (49/92) had passed both their preschool and 5 year assessments. All patients had no to mild regressed ROP. Of those 32.61% (30/92),who failed both the preschool and 5 year review, 3 had threshold ROP; 1 had unilateral total detachment and 26 had no or regressed ROP. Sixteen children had strabismus (11 esotropias and 5 exotropias), 2 of whom required squint surgery; 8 had significant refractive errors and 2 patients had a significant phoria. 14.13% (13/92) patient failed the preschool screening criteria but passed at 5 years. Two had strabismus (1 had surgery), 2 had refractive errors and 2 had a combination of both. None had passed at preschool and failed at 5years. 6.12% (3/49) of those who passed both assessments, 40% (12/30) of those who failed and 30.77% (4/13) of those who only passed the 5 year school check had neurological and other systemic disabilities. Conclusions: This study highlights the need for follow–up of these pre–term babies within the community at an early age, due to the increased ophthalmic morbidity in premature babies, even in absence of advanced ROP. Earlier detection of ophthalmic problems, particularly if they are amenable to treatment, may prevent delay in management, with less disruption on the children’s educational, psychological and social behaviour.

Keywords: retinopathy of prematurity