Characteristics of Infants With Severe Retinopathy of Prematurity in Countries With Low, Moderate, and High Levels of Development: Implications for Screening Programs

TLDR

Retinopathy of prematurity is a potentially avoidable cause of childhood blindness, with its prevalence varying widely across countries depending on neonatal care quality and the presence of effective screening and treatment programs. This observational study aimed to compare the characteristics of premature infants who developed severe ROP between 1996 and 2002 in highly developed versus less developed countries. Data were collected through questionnaires completed by ophthalmologists in low, moderate, and high development countries, who reported birth weights and gestational ages of infants treated for threshold or more advanced ROP. Among 1,091 infants from poorly developed countries, 13.0 % exceeded UK screening criteria and 3.6 % exceeded the <34 weeks GA and/or <1,750 g birth weight threshold, indicating that larger, more mature infants develop severe ROP in low/moderate development settings and that screening criteria should be locally tailored.

Abstract

Retinopathy of prematurity (ROP) is a potentially avoidable cause of blindness in children. The proportion of blindness as a result of ROP varies greatly among countries depending on their level of development, being influenced by the availability of neonatal care, neonatal outcomes, and whether effective screening and treatment programs are in place. The objective of this study was to compare characteristics of premature infants who developed severe ROP between 1996 and 2002 in highly developed countries with less developed countries.This was an observational study. A questionnaire was completed by ophthalmologists in countries with low, moderate, and high development rankings (3 highly developed countries and from 10 less well-developed countries) who screen for ROP in which they supplied birth weights and gestational ages (GAs) of infants who were treated for threshold ROP or identified with more advanced stages of the disease. Birth weights and GAs of infants with severe ROP were measured.The mean birth weights of infants from highly developed countries ranged from 737 to 763 g compared with values ranging from 903 to 1527 g in less developed countries. Mean GAs of infants from highly developed countries ranged from 25.3 to 25.6 weeks compared with 26.3 to 33.5 weeks in less developed countries. A total of 13.0% of 1091 infants from poorly developed countries exceeded United Kingdom screening criteria; 3.6% exceeded a criteria of <34 weeks' GA and/or <1750 g birth weight.These findings suggest that larger, more mature infants are developing severe ROP in countries with low/moderate levels of development compared with highly developed countries. ROP screening programs need to use criteria that are appropriate for their local population.