Retinopathy of Prematurity

The incidence of ROP in India is between 38- 51.9% and it is as high as 80 – 100% in infants weighing <900 gms at birth or with a gestational age of <25 weeks. With the improved NICU care the incidence has increased. Unfortunately there is no proportionate increase in awareness among the medical fraternity. In the absence of an effective screening strategy an increasing number of children who could have been successfully managed are going irreversibly blind. The socioeconomic burden of such childhood blindness is immense.

Screening:

Whom?

Birth weight < 2000 gm (Or)

Gestational Age at <36 weeks (Or)

Any premature baby with severe illness in perinatal period (RDS, sepsis, blood transfusion, IVH, apnoiec episodes, etc) need a retinal examination.

When?

Follow the ‘30 day’ strategy (i.e. the retinal examination should be completed at or before ‘day-30’ of life). Should preferably be done earlier (at 2 – 3 weeks of birth) in very low weight babies (<1200 gm) or in babies with very low gestational age (<28 weeks).

How?

An ophthalmologist (Retina Specialist) can detect ROP by dilated fundus examination.

Management:

The treatment in the form of lasers, intravitreal anti-VEGF injections or surgery is planned to reduce the Chances of unfavourable disease outcomes. Mild forms of ROP may resolve on their own without any active intervention. Severe forms of the disease on the other hand may need medical treatment as long as it is limited to stage 3. Surgical intervention is necessary once the disease reaches stage 4 or 5.

Indirect ophthalmoscopy is done to scan the entire retina and gauge the state of retinal maturity.