Characteristics of treatment-requiring retinopathy of prematurity in a screening program at Aravind Eye Hospital, India

Abstract

Purpose : The International Classification of Retinopathy of Prematurity (ICROP) defines the classification of ROP for clinical trials and treatment guidelines, however ICROP has historically been predominantly influenced by ROP pathology in the US and Europe. Since ROP phenotypes can vary especially in low-and-middle-income countries (LMIC), there is a gap in knowledge as to how applicable ICROP classifications are to treatment in LMIC. In this study, we evaluate the ICROP classifications of all babies treated for ROP at the Aravind Eye Hospital (AEH) in South India.

Methods : A retrospective study was performed on all treatment-requiring (TR) ROP at AEH between April 2019 and November 2020. As part of routine tele-ROP screening, disease was documented by Retcam Shuttle and graders recorded the level of disease by ICROP criteria using a web-based data management system iTeleGENx (Chicago, IL, USA). Diagnosis of TR-ROP and any treatment received were recorded.

Results : A total of 204 eyes of 104 babies were diagnosed with TR-ROP out of 2700 babies (3.9%) screened for ROP during the time interval. The mean ± standard deviation (SD) gestational age was 30 ± 2 wks and average birth weight was 1270 ± 285 g. Using ICROP criteria and current treatment guidelines, 184 eyes of 94 babies (89.5%) were treated according to guidelines with either zone 1, with plus (37.2%), zone 2, stage 3, with plus (42.6%) or zone 1, stage 3 (4.3%). 20 eyes of 10 babies (9.6%) who received treatment had Type 2 ROP ICROP characteristics, presenting with zone 2 stage 3, pre-plus ROP (80%).

Conclusions : We found that approximately 90% of babies were treated according to guidelines established by the ICROP and Early Treatment for ROP (ETROP) study, suggesting that despite demographic and phenotypic differences, the ICROP informs clinical diagnosis and management in LMIC.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Figure 1. Screening images on iTeleGENx of babies diagnosed with ROP that received treatment. (A) Color fundus photograph of patient diagnosed with Type 1 ROP, zone 1, stage 3 with plus disease. (B) Color fundus photograph of patient diagnosed with Type 2 ROP, zone 2, stage 3, pre-plus.