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Validation of the East London Retinopathy of Prematurity algorithm to detect treatment-warranted retinopathy of prematurity: a cohort study
  1. Sonia Moorthy1,
  2. Gillian G W Adams1,
  3. Graham Smith2,
  4. Susmito Biswas3,
  5. Waleed Aliyan4,
  6. Roshni Bhudia5,
  7. Aamir Saiyed6,
  8. Shad Husain7
  1. 1Paediatric Ophthalmology and Strabismus, Moorfields Eye Hospital City Road Campus, London, UK
  2. 2Data Analytics, Omnivide, Sydney, New South Wales, Australia
  3. 3Paediatric Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK
  4. 4Paediatric Ophthalmology, Manchester University NHS Foundation Trust, Manchester, UK
  5. 5Primary Care and Public Health, Imperial College London, London, UK
  6. 6Emergency Department, Cardiff and Vale University Health Board, Cardiff, UK
  7. 7Neonatology, Homerton University Hospital Neonatal Unit, London, UK
  1. Correspondence to Dr Sonia Moorthy, Moorfields Eye Hospital City Road Campus, London, UK; sonia.moorthy{at}

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Retinopathy of prematurity (ROP), a vasoproliferative disorder of the premature retina, is a leading cause of preventable childhood blindness.1–3 More severe forms of ROP occur almost exclusively in infants born at <29 weeks gestational age (GA) and/or birth weight (BW) <1251g4 and, if left undetected and untreated, can lead to devastating vision loss.5

ROP screening criteria universally include GA and BW.6 These demonstrate high sensitivities but are limited by low specificities. In the UK, treatment-warranted ROP (TW-ROP) develops in less than 5% of screened infants.7 Management consists of anti-vascular endothelial growth factor (VEGF) injections8 and/or laser. Over the past three decades, there is an increasing demand for ROP screening due to improved survival of extremely preterm infants.9 This could be addressed through a targeted approach, including the development and application of ROP screening tools with improved specificity, without compromising sensitivity.10

In 2009, the first ROP screening algorithm, Weight, IGF-1, Neonatal Retinopathy of Prematurity (WINROP), first incorporated GA, BW and early weight gain (EWG).11 Since then, several other predictive models have been developed using at least these three variables.11–22 The postnatal growth and ROP development model (G-ROP),16 20 and a modified G-ROP (G-ROP 180g)20 have been studied in the largest number of infants to date. Both G-ROP and G-ROP 180g have sensitivities of 100% with narrow 95% CIs to detect type 1 ROP, and the potential to reduce the number of infants who require screening by about a third.20

As ethnicity is also a factor associated with the development of severe ROP,21 we developed the East London Retinopathy of Prematurity (EL-ROP)22 algorithm,incorporating this variable in addition to GA, BW and EWG (EWG, defined as weight gain during the first 6 weeks of life). EL-ROP was developed …

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  • 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.

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

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