Abstract
Purpose :
To establish baseline performance data for a process/quality improvement (PI/QI) program for detection and follow-up of Military Health System (MHS)-eligible infants at risk for retinopathy of prematurity (ROP).
Methods :
All births in the MHS from 2016-2019 were identified in the M2 database. Demographic information and gestational age were extracted, and ROP diagnosis, laterality, and stage were determined by ICD-10 codes. Infants at risk for sequelae of ROP were defined as those born <31 weeks GA and/or were diagnosed with ROP during the birth admission. Outpatient claims from military and civilian providers were linked to each at-risk infant, and the timing and diagnoses of each claim determined. Secondary visual diagnoses were determined by ICD-10 code. Chi-squared tests determined differences in percentages, and non-parametric tests determined differences in medians.
Results :
1,457 (91.6% of all at-risk infants) could be matched to outpatient claims and formed the population for analysis. 404 infants (27.7%) were diagnosed with ROP. 114 (28.2%) were initially diagnosed with Stage 0, 127 (31.4%) with stage 1, 77 (19.1%) with stage 2, 31 (7.7%) with stage 3, 13 (3.2%) with stage 4 and 5 (1.2%) with stage 5. 37 (9.2%) had unknown stage. The 50th percentile time from birth to first ophthalmic examination was 34 days (IQR 29-48 days). The median first follow-up after discharge for patients with ROP occurred at 18.5 days.
Compared to at-risk patients not diagnosed with ROP, ROP patients had a higher prevalence of strabismus (16% vs 9.6%; p<0.001), refractive error (41% vs 28%, p<0.001), and visual disturbance (12% vs 9.0%; p=0.04). There was no significant difference in the prevalence of blindness and low vision (0.3% vs 0.5%; p=0.73) and nystagmus (1.5% vs 1.2%; p=0.35). Only one patient in the ROP group developed a retinal detachment and none in the non-ROP group (p=0.05).
Conclusions :
Retinopathy of prematurity is a high risk, low volume ophthalmic condition for which many MHS-eligible beneficiaries are at risk. The incidence of ROP in infants born in the MHS is similar to infants in other large single payer systems although the incidence of severe ROP stage 4 and 5 may be higher. These patients are at increased risk for strabismus and refractive error and require frequent long-term outpatient follow-up.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.