Retinopathy of prematurity is a retinal ischemic disorder that affects low-birth-weight infants. Development of an international classification system has permitted standardization of diagnosis using parameters such as zone, stage, and presence of plus disease.1,2
Landmark multicenter randomized controlled trials, such as the Cryotherapy for ROP (CRYO-ROP) and Early Treatment for ROP studies, have established guide-lines for identifying treatment-requiring disease.1,3
Newer treatment methods, such as intravitreal bevacizumab, have shown promise as pharmacologic approaches to severe disease.4
Current management recommendations from these studies are that type 2 ROP (zone I, stage 1 or 2, without plus disease; or zone II, stage 3, without plus disease) should be observed very carefully. Type 1 ROP (zone I, any stage, with plus disease; zone I, stage 3, with or without plus disease; or zone II, stage 2 or 3, with plus disease) should be treated with laser photocoagulation or cryotherapy to decrease the likelihood of visual loss and blindness.1–3
This means that the presence of ROP in zone I or plus disease is the most important finding to guide management decisions. A joint statement by the American Academy of Pediatrics, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus describes criteria for identifying at-risk infants who require ROP examination.5
Retinopathy of prematurity continues to be a leading cause of childhood blindness throughout the world. Approximately 2100 infants in the United States are affected annually by long-term sequelae of ROP, such as retinal detachments, macular folds, and amblyopia, and 400 to 900 develop blindness each year.6,7
In most developed countries, ROP accounts for 6% to 18% of pediatric blindness. In middle-income countries in Latin America and Asia, this rate has been found to be 15% to 35%.8–12
A shortage of ophthalmologists with the capability and willingness to screen babies in neonatal intensive care units (NICUs) for ROP continues to be a major reason that blindness occurs at such a high rate in many middle-income countries.10
Retinopathy of prematurity examinations with binocular indirect ophthalmoscopy (BIO) have been effective at detecting disease. However, there are important limitations to this screening method: (1) BIO examinations are logistically difficult, and they require time and effort to travel to NICUs and to coordinate with neonatology staff; (2) the number of infants at risk for ROP is increasing because of higher premature birth rates and improved neonatal care, both of which increase the burden for ophthalmologists who continue to perform examinations13
; (3) there is substantial medicolegal exposure associated with ROP care, which may be heightened by lack of objective documentation for BIO findings; and (4) documentation of BIO findings using traditional paper-based retinal drawings may be qualitative and imprecise.14
As a result of these factors, an academy survey found that only half of retinal specialists and pediatric ophthalmologists were managing ROP, and that >20% of them planned to stop in the near future (Ocular Surgery News U.S. Edition 2006. Survey: Physicians being driven away from ROP treatment. Available at http://www.osnsupersite.com/view.aspx?rid=18018
. Accessed September 7, 2011).
Wide-angle digital retinal photography using a commercially available device has been performed for >10 years. Retinal photography may improve the objective documentation of disease findings, increase the accuracy and standardization of diagnosis, and create digital libraries for education and research.14,15
This may eventually improve the accessibility, cost, efficiency, and safety of ROP care through telemedicine.16–21
In the future, digital retinal photography may provide novel opportunities to obtain second opinions and consultations from remote experts, as well as education about uncommon variable clinical presentations such as aggressive-posterior ROP.