What do you do about ROP screening in “big” babies?
- Pediatric Ophthalmology, Wood Center, 1st Floor, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA; quinn@email.chop.edu
Screening guidelines should not be considered generalisable to all nursery populations . . . regional differences must be taken into account
World Health Organization guidelines for effective screening programmes1 demand several conditions be met, but these conditions are still being understood for retinopathy of prematurity (ROP) screening. There is little doubt that ROP is an important health problem in the premature infant population and that peripheral retinal ablation is an accepted treatment for patients with recognised disease. In addition, much is known about the natural history of the condition and the disorder can readily be detected by indirect ophthalmoscopy. However, as Andruscavage and Weissgold point out in their article in this issue of the BJO (1127), there is not yet an agreed policy on whom to treat as patients, in particular what should the criteria be for ROP screening in children with birth weights larger than 1250 g? Society must also address the cost of finding cases that only rarely occur in higher birthweight, but still preterm, babies.
Results of the randomised Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP)2 have shown that, for 10 year old children with birth weights of <1251 g born in the United States in 1986 and 1987, treatment within 72 hours of the diagnosis of threshold disease resulted in a 28.5% reduction in the number of treated eyes with visual acuity of 20/200 or worse (p<0.001) compared to control eyes. There was also a 43.2% reduction of treated eyes with retinal folds involving the fovea or total retinal detachment, compared to eyes in the control group (p<0.001). The cohort of children that constitutes the CRYO-ROP study population accounted for approximately 15% of the <1251 g birthweight …
