Risks of advanced ROP development in unscreened babies

1 April 2025 | Fiona Rowe (Prof) | EYE - Paediatrics, EYE - Strabismus

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The authors report a retrospective study of the prevalence of infants with stage 4b and 5 retinopathy of prematurity (ROP) who were never screened and the importance of screening guidelines. The study was conducted in a tertiary eye hospital in South India and included 220 eyes and 110 premature infants. Mean birth weight (BW) was 1125 ±360g (92 <1500g), mean gestational age (GA) was 28 ±2 weeks (100 <32 weeks), and mean age at presentation was 42 ±82 weeks (median 17 weeks, range 2.86–59). Fifty had bilateral stage 5 ROP, 17 unilateral stage 5 with stage 4b in the other eye, 15 bilateral stage 4b and 23 stage 4b in one eye and stage 4a/3 in the other eye. Of those with stage 5, 90% were referred from neighbouring districts / states. Fifty-two required surgery. Of 100 infants, 28 were self-referred, 80 referred by an ophthalmologist after late screening or loss to follow-up or further management needed, one was referred through tele screening, and one referred by paediatricians. The primary reason for presentation with stage 5 ROP was white reflex, and involuntary or wandering eye movements. Factors associated with ROP severity included post-conception age and age at presentation. The department rate for any stage ROP was 7.3%: 26.6% of those needing treatment. Advanced ROP was 0.16% of preterm births. The authors propose reasons for advanced ROP as unmonitored oxygen supplementation in the NICU, lack of knowledge and awareness among neonatologists and parents, unavailability of trained ophthalmologists and lack of implementation of screening protocols. They noted an inability to follow screening guidelines from the UK or USA because they see more heavier infants with severe ROP. Many infants had no ROP screening with presentation due to social barriers and peer pressure. Some had no transport facilities or infants were too sick for transfer. The study highlights the need for better ROP screening with improved awareness of screening for cohorts in lower- and middle-income countries that differ to other countries.