AAP Updates Screening Policy for ROP

Nicola M. Parry, DVM

December 04, 2018

Premature infants require regular screening for retinopathy of prematurity (ROP), according to an updated policy statement from the American Academy of Pediatrics (AAP).

The statement, which was published online November 26 in Pediatrics, revises a 2013 statement on screening of preterm infants for ROP, a developmental disorder of the eye and a leading cause of blindness in childhood.

Walter M. Fierson, MD, FAAO, FAAP, from the AAP Section on Ophthalmology, and colleagues highlight the need for experienced ophthalmologists to perform carefully timed examinations of at-risk infants. The examinations should be performed on the basis of the infant's gestational age at birth and subsequent disease presence and severity.

"The goal of an effective ROP screening program is to identify infants who could benefit from treatment and make appropriate recommendations on the timing of future screening and treatment interventions," they write.

“Because undiagnosed or treatment-delayed ROP can lead to permanent blindness, it is important that all infants who are at risk be screened in a timely fashion, recognizing that not all infants require treatment."

Like the previous statement, the updated version recommends retinal screening examinations using binocular indirect ophthalmoscopy for infants with a birth weight of 1500 g or less or a gestational age of 30 weeks or less, and also for certain at-risk infants with a birth weight from 1500 g to 2000 g.

The updated statement includes new recommendations that address various issues, such as the use of remote photographic screening for ROP. In this process, an examining ophthalmologist in a neonatal care unit conducts digital photo screening for ROP, then forwards the images to a remotely located ophthalmologist who has experience in ROP. That opthalmologist then provides expert interpretation.

The statement also recommends that "indirect ophthalmoscopy be performed at least once by a qualified ophthalmologist before treatment or termination of acute-phase screening of ROP for infants at risk for ROP."

The authors write that ophthalmologists should consider using intravitreal injection of anti–vascular endothelial growth factor (VEGF) agents to treat aggressive posterior ROP They discuss recent data that support the promise of these agents in this setting. For example, in infants with stage 3+ ROP, studies have shown that intravitreal injection of bevacizumab (Avastin, Genentech) is effective and may lead to significantly better structural results for zone I disease than is possible with laser ablation.

However, ophthalmologists should be aware that, compared with conventional laser peripheral retinal ablative treatment, anti-VEGF treatment tends to be associated with much later recurrence of ROP.

The statement highlights the importance of interprofessional care in the management infants with ROP. For example, it recommends that neonatology and ophthalmology services in each neonatal intensive care unit establish specific criteria (such as infant birth weight and gestational age) that will automatically trigger screening for ROP.

Interprofessional collaboration is also important with regard to the transition of care of infants. "The transferring or discharging pediatrician, after consultation with the examining ophthalmologist, has the responsibility for communicating to the receiving physician what eye examinations are needed and their required timing," the statement concludes.

The authors caution that infants who have had ROP are at increased risk of developing unrelated visual disorders, such as strabismus, amblyopia, high refractive errors, cataracts, and glaucoma. Therefore, infants who have had ROP require ophthalmologic follow-up for these potential problems within 4 to 6 months after discharge from the neonatal intensive care unit.

One committee member reports having research relationships with the National Institutes of Health and the National Science Foundation, a consulting relationship with Novartis, and stock ownership in Inteleretina. He also reports having an unpaid advisory board relationship with Clarity Medical Systems. No other significant relevant financial relationships have been disclosed.

Pediatrics. Published online November 26, 2018. Full text

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