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Cagri G Besirli, Rebecca Vartanian, John Barks, Chris A Andrews, David C Musch; Current Trends and the Future of Retinopathy of Prematurity (ROP) Screening and Treatment in the United States. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6307. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the current practice patterns of ROP screening and treatment and the attitudes towards new screening and treatment modalities in level 3 and level 4 NICUs reported by medical directors.
Paper surveys were mailed to the medical directors of 840 level 3 and 4 NICUs identified in the 2011 American Academy of Pediatrics (AAP) directory. Categorical variables were summarized by counts, percentages, and bar graphs; continuous variables by means, standard deviations, and histograms. Responses were compared to AAP guidelines and previous reports. Within sample comparisons were made by level, setting, size, and academic status. Analyses were performed in R 3.2.2 (R Foundation for Statistical Consulting, Vienna, Austria).
Responses were received from 393 (47%) of the survey recipients. Respondents indicated that ROP screening is performed in their NICUs by pediatric (61%) and/or retina (43%) specialists; retinal imaging devices are infrequently used (21%). Treatment is performed by pediatric (39%) and/or retina (69%) specialists in the NICU under conscious sedation (60%). The most common treatment modality was laser photocoagulation (85%), followed by anti-VEGF injection (20%). Some NICUs did not provide screening (2%) or treatment (28%) services, often due to lack of ophthalmologists (78%). Respondents showed slightly more agreement (35%) than disagreement (25%) that a retinal imaging device could replace indirect ophthalmoscopy (40% neutral). More respondents agreed (30% vs 15%) that telemedicine for ROP screening is safe, but most were neutral (55%). Only 15% agreed that a well-trained non-physician could reliably review telemedicine images, while 49% disagreed.
Ophthalmologists perform the majority of ROP screening examinations and treatment in the U.S, while telemedicine is infrequently used as the primary method of screening. Most NICUs reported that infants are treated primarily with laser ablation in the NICU under conscious sedation. While the decreasing number of ophthalmologists available for screening and treating ROP is expected to increase the use of telemedicine, only a minority of respondents agreed that telemedicine is a safe screening modality.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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