Abstract
Purpose :
The burden of screening for retinopathy of prematurity (ROP) is challenging even in high-income countries. This study was performed to validate the TWO-ROP algorithm, which proposes limited screening for infants who do not meet both gestational age (GA) and birth weight (BW) criteria.
Methods :
Retrospective study of infants screened from 2013 to 2023. We collected GA at birth, BW, age at ROP diagnosis, ROP zone and stage, presence of plus disease, and ROP treatments. Rates of ROP and treatment-warranted ROP (TW-ROP) were evaluated in group 1 (BW<1500 g, GA≥30 weeks), group 2 (BW≥1500g, GA<30 weeks), and group 3 (BW≥1500g, GA≥30 weeks). Categorical data were analyzed with Chi-square test and continuous variables were compared with analysis of variance.
Results :
Of the 3,930 screened infants, 1,095 (27.9%) met the inclusion criteria. The number of patients in groups 1, 2, and 3 were 837 (76.4%), 72 (6.6%), and 186 (17.0%), respectively. ROP was detected in 106 out of 1095 (9.7%) patients; within each group, the rate was 9.1% (76 patients) in group 1, 18.1% (13 patients) in group 2, and 9.1% (17 patients) in group 3 (p=0.045). The mean corrected GA at ROP diagnosis was 37.3 weeks for group 1, 35.1 weeks for group 2, and 37.7 for group 3 (p=0.026). The mean interval between birth and ROP diagnosis was 47.3 days (range 26-108 days) in group 1, 44.2 days in group 2 (range 30-79 days), and 52.5 days (range 25-95 days) in group 3 (p=0.477). Within ROP patients, 88 (8.0%) had stage 1, and 13 (1.2%) had stage 2 in their worst eye. Stage 3 was found in 9 eyes of 5 patients (0.5%, all zone II). Three eyes of 2 patients (0.2%) had plus disease. No zone 1, stage 4, or stage 5 cases were recorded. Two patients had bilateral laser treatment at mean 40.3 weeks corrected GA; 3 out of 4 of these eyes met Type 1 treatment criteria.
Conclusions :
The previously published TWO-ROP algorithm suggested that for infants meeting 0 or 1 screening criterion, a single screening exam prior to or just after discharge from the NICU could alleviate ROP examination burden while maintaining safety. Given the current validation results with two patients with TW-ROP, our recommendation is that the proposed single screen occurs prior to discharge to ensure timely diagnosis, follow-up, and treatment.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.