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New modifications of Swedish ROP guidelines based on 10-year data from the SWEDROP register
  1. Gerd Holmström1,
  2. Ann Hellström2,
  3. Lotta Gränse3,
  4. Marie Saric4,
  5. Birgitta Sunnqvist5,
  6. Agneta Wallin6,
  7. Kristina Tornqvist3,
  8. Eva Larsson1
  1. 1 Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
  2. 2 Section for Ophthalmology, Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  3. 3 Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
  4. 4 Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
  5. 5 Department of Ophthalmology, Länssjukhuset Ryhov, Jönköping, Sweden
  6. 6 St Erik Eye Hospital, Stockholm, Sweden
  1. Correspondence to Prof Gerd Holmström, Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala 75185, Sweden; gerd.holmstrom{at}


Background/aims During the last decade, improved neonatal care has resulted in increased survival of the most immature infants and improved health of more mature infants. We hypothesise that this has affected incidence and treatment of retinopathy of prematurity (ROP), enabling guidelines for screening to be modified.

Methods In Sweden, all infants with gestational age (GA) at birth ≤30 weeks are screened for ROP. Results are registered in a web-based register, Swedish National ROP Register, with a coverage rate of 97%. Incidence of ROP and frequency of treatment, aspects on natural course of ROP and number of examinations, are calculated in relation to GA at birth in infants born during 2008–2017.

Results Of 7249 infants, 31.9% (2310) had ROP and 6.1% (440) were treated. No infant with GA 30 weeks was treated. Incidence of ROP remained similar, but frequency of treatment increased (p=0.023). Over time, GA and birth weight were reduced in infants with ROP and with treated ROP. In the most immature infants, postmenstrual age was lower and postnatal age was higher when any ROP and stage 3 ROP were first detected (p<0.001). At treatment, postmenstrual but not postnatal age of the infant was associated with GA (p<0.001). During the 10-year period, 46 038 examinations were performed.

Conclusion Modification of Swedish guidelines is proposed, including only infants with a GA of <30 weeks and postponing the first examination with 1 week in infants with GA 26–29 weeks. This would spare many infants from stressful examinations and reduce eye examinations with at least 20%.

  • retina
  • child health (paediatrics)
  • epidemiology

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  • Contributors GH and EL are responsible for data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the ethics committee of the Faculty of Medicine, Uppsala University, Sweden (Dnr 2010/117/2).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request. All data relevant to the study are included in the article or uploaded as supplementary information.

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