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Eye (Lond). 2016 April; 30(4): 636–637.
Published online 2016 January 22. doi:  10.1038/eye.2015.279
PMCID: PMC5108540

Do we screen very premature babies too early for retinopathy of prematurity?

Sir,

Retinopathy of prematurity (ROP) is a disorder of retinal vascular development in preterm infants. ROP accounts for approximately 3% of all cases of severe visual impairment and blindness in childhood in the UK.1 Early diagnosis and treatment can largely prevent visual loss caused by ROP. Screening examinations are known to cause significant discomfort and distress.2, 3

The most recent UK Retinopathy of Prematurity Guideline was introduced in May 2008.4 All babies born less than 32 weeks gestational age (GA) (up to 31 weeks and 6 days) or less than 1501 g birth weight should be screened for ROP. Infants born before 27 weeks GA (ie up to 26 weeks and 6 days) should have their initial ROP screening examination at 30−31 weeks postmenstrual age (PMA).

We reviewed the screening records of all premature babies born prior to 27 weeks (26 weeks and 6 days) GA and subsequently screened at 30 weeks (up to 30 weeks and 6 days) in a single unit in Edinburgh between February 2005 and February 2015. Sixty-eight infants were identified.

Forty-four of the examined infants had tunica vasculosa lentis/persistent fetal vasculature, which limited the fundal view. Five screening examinations had to be postponed owing to absence of any fundal view.

Three babies had ROP. Two had Zone II Stage 1 with no plus disease and one had Zone II Stage 3 with no plus disease. Treatment was not required for any infant at the time of this initial examination. All infants were followed up within a 1 to 2 week interval until they met the termination of ROP screening criteria or developed ROP and received treatment; according to the criteria set out in the guidelines.

We suggest that the UK screening guideline could be revised to a first ROP screening examination for premature babies born prior to 27 weeks to be performed at 31 weeks (31 weeks and zero days to 31 weeks and 6 days) PMA. This revision would align the UK screening protocol with the current American Academy of Pediatrics/American Academy of Ophthalmology/American Association of Pediatric Ophthalmology and Strabismus recommendation for 22–27 weeks GA infants to initiate screening at 31 PMA.5 Data from other neonatal units in the UK are needed to add confidence to this suggestion.

This change would allow premature babies an additional week before their first examination to stabilise without compromising their safety.

Notes

The authors declare no conflict of interest.

References

  • Rahi JS, Cable N, , British Childhood Visual Impairment Study Group.. Severe visual impairment and blindness in children in the UK. Lancet 2003; 362(9393): 1359–1365. [PubMed]
  • Laws DE, Morton C, Weindling M, Clark D. Systemic effects of screening for retinopathy of prematurity. Br J Ophthalmol 1996; 80(5): 425–428. [PMC free article] [PubMed]
  • Rush R, Rush S, Nicolau J, Chapman K, Naqvi M. Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity. Retina 2004; 24(2): 242–245. [PubMed]
  • Wilkinson AR, Haines L, Head K, Fielder AR. UK retinopathy of prematurity guideline. Eye 2008; 23(11): 2137–2139. [PubMed]
  • Fierson WM, , American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2013; 131(1): 189–195. [PubMed]

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