Evidence-Based Schedule for Retinopathy of Prematurity (ROP) Examinations
Gil Binenbaum; Alejandra de Alba Campomanes; Amy Hutchinson; Michael Yang; Gui-shuang Ying;
On Behalf of the G-ROP Study Group
Children’s Hospital of Philadelphia
Introduction: We sought to develop evidence-based recommendations for scheduling and termination of acute phase ROP examinations.
Methods: Secondary analysis of multicenter retrospective study of infants undergoing ROP examinations at 29 North-American hospitals, 2006-2012 (G-ROP Study). Analysis was by eye. Outcomes were timing for starting examinations, inter-examination intervals, and terminating examinations; based upon earliest, soonest, and latest occurrences of Type 1 ROP, respectively; and with respect to stage (S), zone (Z), and postmenstrual age (PMA) of current examination. Gestational age (GA) and birth weight (BW) strata were analyzed to further refine recommendations. Only Stage/zone strata with minimum 650 examinations (range 651-11,041) were considered.
Results: 39,943 individual eye diagnoses of 8,334 infants were studied. Type 1 ROP occurred in 838 eyes. Exams should begin by 31-weeks-PMA (PMA-31) for GA<27 weeks, or age 6 weeks for GA>=27 weeks. Inter-examination intervals could be S0Z1 1-2 weeks; S1Z1 1 week; S2Z1 </=1 week; S0Z2 2 weeks; S1Z2/3 2 weeks; S2Z2/3 1 week; S3Z2/3 </=1 week; S0Z3 2 weeks. Intervals could safely be lengthened for persistent S0, S1, S2, S3, after PMA-40, 41, 44, 44, respectively, or S0 after PMA-36 if BW>750g or GA>28 weeks. Acute phase examinations could be terminated for ‘Mature’; ‘Regressed’; or S0Z3 without prior disease in Z1or2 after PMA-37 or at any PMA if GA>28-weeks.
Discussion: Clinical judgment could be used to adjust these intervals, for pre-plus-changes, rapid progression, or clearly regressing disease.
Conclusion: Modification of current ROP schedules should be considered, based upon these data from a large cohort representative of infants receiving examinations.
References: Binenbaum G, Tomlinson L, on behalf of the G-ROP Study Group: Postnatal Growth and Retinopathy of Prematurity Study: Rationale, Design, and Subject Characteristics. Ophthalm Epidem 24(1): 36-47, Feb 2017.