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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 8  |  Issue : 1  |  Page : 47-48

Retinopathy of prematurity: Screening challenges


1 Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidhyapeeth, Puducherry, India
2 Vitreo-Retina Services, Aravind Eye Hospital, Puducherry, India

Date of Web Publication6-Mar-2020

Correspondence Address:
Krishnagopal Srikanth
Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidhyapeeth, Pilliyarkuppam, Puducherry - 607 402
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_21_19

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How to cite this article:
Anudeep K, Srikanth K, Sindal MD, Jha KN. Retinopathy of prematurity: Screening challenges. J Clin Ophthalmol Res 2020;8:47-8

How to cite this URL:
Anudeep K, Srikanth K, Sindal MD, Jha KN. Retinopathy of prematurity: Screening challenges. J Clin Ophthalmol Res [serial online] 2020 [cited 2020 May 30];8:47-8. Available from: http://www.jcor.in/text.asp?2020/8/1/47/280210



Sir,

Retinopathy of prematurity (ROP) is a major cause of childhood blindness in the world.[1] ROP is a disease of the retina that affects preterm, low birth weight infants and has the potential to cause permanent and irreversible blindness which can be preventable. This letter describes about the screening guidelines of ROP and challenges encountered during the screening of preterm babies.

We conducted a prospective study on incidence, risk factors, and treatment outcomes in ROP in our hospital. The study included 80 preterm babies who were at a high risk of developing ROP. The criteria for inclusion were babies with birth weight <1700 g, gestational age <34 weeks at birth, exposure to oxygen, multiple gestations, respiratory distress syndrome and with maternal complications such as gestational diabetes mellitus, gestational hypertension, and antepartum hemorrhage.[2] Fundus evaluation was done by fellowship-trained vitreo-retina specialists. High-risk babies and babies with features of ROP were screened at weekly intervals. Babies who required treatment were treated with laser photocoagulation, and follow-up was done for 6 months until ROP had regressed.

We faced few challenges during the screening of these babies. Babies who were at risk of developing ROP were asked to review weekly. Of 80 preterm babies screened 15 (18.75%) babies were lost for follow-up. 10 (12.5%) babies who were diagnosed with immature retina did not complete all follow-up examinations because of travel issues from rural areas. 3 (3.75%) babies in neonatal intensive care unit (NICU) were not screened and referred to higher centers because of their poor systemic condition. 2 (2.5%) babies expired due to systemic illness. In screening babies with ROP, follow-up is very important as it can progress to aggressive posterior ROP and stage 4 or stage 5 ROP within weeks.

If travel for families is difficult and a major factor in the lack of complete screening, telemedicine may be a feasible option.[3] Rural community physicians and nurses can be trained to take digital retinal images, and these images can be sent to the pediatric ophthalmologists for review. This would eliminate travel for families. Telemedicine has been shown to be cost-effective in developed countries.[4] Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity was initiated in 2007 to address the problems of unscreened rural and semi-urban premature infants for ROP using telemedicine and employing nonphysician graders who travel to remote NICUs.[5]

Community engagement also plays a significant role in ensuring adequate ophthalmologic follow-up. Community education about the risks of ROP, potential blindness, importance of screening, and treatment when necessary should be stressed. A more organized system for ophthalmologic follow-up is needed, especially when infants are discharged early from NICU before the examination. Contact information must be obtained, including information for family members and phone numbers to ensure screening is completed. More research is needed into new technologies that can be feasibly incorporated and cost-effective. Proper screening and timely intervention prevent severe vision loss due to ROP. There is a need to increase the awareness of the disease to make sure these babies can be treated on time. Sensitization of pediatricians to refer babies for ophthalmologic follow-up is required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gilbert C, Fielder A, Gordillo L, Quinn G, Semiglia R, Visintin P, et al. Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: Implications for screening programs. Pediatrics 2005;115:e518-25.  Back to cited text no. 1
    
2.
Jalali S, Anand R, Kumar H, Dogra MR, Azad R, Gopal L. Programme planning and screening strategy in retinopathy of prematurity. Indian J Ophthalmol 2003;51:89-99.  Back to cited text no. 2
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3.
Shah PK, Ramya A, Narendran V. Telemedicine for ROP. Asia Pac J Ophthalmol (Phila) 2018;7:52-5.  Back to cited text no. 3
    
4.
Jackson KM, Scott KE, Graff Zivin J, Bateman DA, Flynn JT, Keenan JD, et al. Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management. Arch Ophthalmol 2008;126:493-9.  Back to cited text no. 4
    
5.
Vinekar A, Gilbert C, Dogra M, Kurian M, Shainesh G, Shetty B, et al. The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting. Indian J Ophthalmol 2014;62:41-9.  Back to cited text no. 5
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