Screening for Retinopathy of Prematurity May Start at 31 Weeks

Laurie Barclay, MD

February 28, 2011

February 28, 2011 — Screening for retinopathy of prematurity (ROP) may safely start at 31 weeks of postmenstrual age (PMA), according to the results of a national prospective study reported in the February issue of Archives of Ophthalmology.

"Prevention of severe visual impairment due to ...ROP requires efficient screening for detection of severe retinopathy and initiation of treatment at the correct time," write Dordi Austeng, MD, PhD, from the Department of Neuroscience, Uppsala University in Uppsala, Sweden, and colleagues.

"The first screening guidelines for ROP were developed in the late 1980s, when the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) reported results showing that cryotherapy was an effective treatment. However, such guidelines have to be adjusted to local populations and health care and need to be continuously modified and improved."

The goal of the study was to evaluate ROP screening during a 3-year period in a national cohort of infants born before 27 weeks of gestation. Between April 1, 2004, and March 31, 2007, a national prospective study of neonatal morbidity in extremely preterm infants was carried out in Sweden. In the fifth postnatal week, screening for ROP began, and it was continued weekly until complete vascularization of the retina or until regression of ROP.

Of 506 infants studied, 84.8% had the first eye examination performed no later than the sixth postnatal week. In 96.2% of infants, the last examination was performed at PMA of 38 weeks or later. In the total cohort, the mean and median numbers of days between examinations were 8.6 and 7.9 days, respectively (range, 1 - 27.8 days), and the mean and median numbers of examinations were 12 and 10, respectively. Treatment of most infants occurred during a limited period; for example, 75.0% of infants had been treated at a PMA of 39 weeks.

"The objective of screening for ROP is timely detection of ROP before reaching treatment of criteria, i.e., type 1 ROP, according to the Early Treatment for ROP recommendations," the study authors write. "In our population of infants born before 27 weeks' gestation, the first examination could safely be postponed until PMA of 31 weeks because the onset of ROP stage 3 did not occur before then and criteria for treatment were not reached before PMA of 32 weeks. Gestational age at birth and PMA at the time of examination should be considered when deciding when and where the next examination should be performed."

Limitations of this study include inability to draw extensive conclusions from the findings because it was not designed to study regression of ROP.

"Based on our findings, we propose modifications of guidelines for ROP screening of infants born before 27 weeks' gestation," the study authors conclude. "We recommend postponing the first examination until PMA of 31 weeks, which will reduce costs and several stressful examinations in the youngest infants."

This study was supported by The Birgit and Sven Håkan Olsson Foundation, Drottning Silvias Jubileumsfond, Evy and Gunnar Sandberg Foundation, and Kronprinsessan Margarethas Arbetsnämnd för Synskadade. The study authors have disclosed no relevant financial relationships.

Arch Ophthalmol. 2011;129:167-172. Abstract


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