ROP Screening

With improvement in neonatal care and survival of very low birth weight babies in India, there is an alarming increase in the incidence of retinopathy of prematurity (ROP). While the problem is on the decline in developed countries due to robust screening programs in place, most developing countries including India are presently experiencing the third epidemic of ROP. One of the most important steps in tackling this giant is to have an appropriate and effective screening strategy.

Who needs ROP Screening.

• Children born below the gestational age of 36 week.
• Children who had birth weight less than 1500gm.
• Children who had to get admitted in ICU after birth.
• Children who needed oxygen therapy.
• Children who had any severe life-threatening issues after birth.
• All these children need ROP screening.

Natural history data from studies have shown that Progression of ROP follows a distinct sequence according to the post-menstrual age (PMA) of the baby.

Retinal findings indicative of poor outcome are seen in only 1% of infants before 31 weeks PMA and in only 1% of infants after 46.3 weeks PMA. The median age for detection of stage 1 ROP is 34 weeks. Pre-threshold ROP appears at 36 weeks of post-menstrual age and threshold disease at 37 weeks. Vascularization is complete by 40 weeks of gestation.

Thus the crucial period for detection of ROP is from 32 weeks to 40 weeks of post-menstrual period. The critical phase is from 34-35 weeks to 37-38 weeks age during which the progression of the disease takes place and treatment may have to be instituted.