Practice Patterns for Retinopathy of Prematurity Examination
Zachary P. Elkin; Gui-shuang Ying; Gil Binenbaum
Children’s Hospital of Philadelphia
Introduction: Published guidelines provide recommendations for retinopathy of prematurity (ROP) examination timing and completion. However, patient-level data describing ophthalmologist practice patterns for such decisions have not been reported. We sought to describe current practices of intervals between ROP examinations and timing for terminating acute phase examinations.
Methods: Secondary analysis of all ROP examination data from a multicenter retrospective cohort study of infants undergoing ROP examinations at 29 North-American hospitals during 2006-2012 (G-ROP Study). Analysis was completed by infant-examination. Distribution of inter-examination intervals, stratified by ROP diagnosis in the worse eye, was assessed. Comparison was made to American Academy of Pediatrics guidelines, as proportions completed during the recommended time interval (‘agree’), ‘earlier’, or ‘later.’
Results: 8,334 infants underwent 32,409 examinations. Overall, 23,604 (72.8%) inter-exam intervals ‘agreed’ with published guidelines, 4,996 (15.4%) were ‘earlier’, and 2,125 (6.5%) were ‘later.’ ‘Later’ follow-up was particularly high for ‘immature-zone-1’ (46%, with 5% >3 weeks; ); regressing-zone-2 (24%), ‘stage-1-zone-3’ (23%), and ‘regressing-zone-3’ (21%). Acute-phase ROP screening was terminated for 98.8% of 3259 ‘mature retina’ and 88.4% of 637 ‘regressed ROP’, but only 53.7% of 4066 ‘immature-zone-3 without prior ROP.’ 94.4% of 763 ‘Type 1 ROP’ cases received treatment within the recommended 72 hours; 39 (5.1%) had treatment beyond 3 days.
Discussion: Practice patterns for ROP examination timing were described in a large cohort representative of infants undergoing screening in North America. Additional investigation is needed to determine why intervals are often longer than recommended for immature-zone-1; one reason might be postponement by the neonatal team.
Conclusion: Ophthalmologists performing ROP examinations choose inter-exam intervals similar to or earlier than recommended guidelines for 88% of examinations.
References: AMERICAN ACADEMY OF PEDIATRICS Section on Ophthalmology. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2013;131:189-195