There are essentially three ways in which blindness from retinopathy of prematurity (ROP) can be prevented, including elimination of premature birth, changes in neonatal care, and improved detection and treatment of established sight threatening retinopathy. It is on the latter that the attention and efforts of the ophthalmic community have been focused, leaving the first two to the paediatricians, perinatologists, neonatologists, nurses, and others who care for these tiny babies. What Darlow et al have done in the paper in this issue of the BJO (p 1592) is direct our attention to the second possibility—that is, neonatal care may be able to be altered to decrease the incidence of potentially blinding disease.

Darlow et al document a remarkable variability in the prevalence of severe ROP among the nurseries in the neonatal intensive care units in the Australian and New Zealand Neonatal Network. Such variability is generally expected when morbidity or mortality results are compared across centres, even in …