Abstract
Objectives: To study preferences in treatment, follow-up and conclusion of examination in infants treated with and without bevacizumab (IVB) and/or laser photocoagulation for retinopathy of prematurity (ROP).Methods: A 22 question web survey was administered to physicians to understand practice patterns for treatment of type1 ROP, determine timeframe of conclusion of examinations with and without IVB/laser, and to approximate incidence of ROP recurrence post-treatment.Results: The survey revealed that 73% pediatric ophthalmologists reported not personally performing injections and 54.1% reported not performing laser. In infants with persistent avascular retina without pre-threshold disease, 54.2% continued examination > 50 weeks PMA, 23.3% discontinued at 50 weeks PMA, 3.2% preferred prophylactic laser and 5.1% fluorescein angiography and laser prior to concluding exams. 46.3% of physicians preferred IVB as primary monotherapy, 37.3% laser, and 16.4% both IVB and laser in type 1 ROP. Of those who preferred IVB, 20.4% concluded examination at ? 55 weeks PMA, whereas 79.6% continued evaluation >55 weeks PMA (60 to ? 80 weeks). Of those who preferred both IVB and laser, 50.6% concluded examination at ? 50 weeks PMA, whereas 49.4% continued > 50 weeks (60 to ? 80 weeks). 21.1 % of respondents reported recurrence with IVB and 8.8% with dual therapyConclusions: Treatment preferences and conclusion of examination in ROP varies considerably without and with treatment. Though a longer follow-up is recommended with IVB, this survey reveals extended examinations beyond 50 weeks PMA in infants with persistent avascular retina requiring no treatment and in the laser treated subgroup. The survey highlights low rates of performing treatments personally by pediatric ophthalmologists, and distinctlyvariable practice patterns in ROP care
Highlights
Retinopathy Of Prematurity (ROP) is the second leading cause of blindness in infants in the United States and is an important source of childhood visual impairment worldwide [1,2,3]
Current models suggest a biphasic process in which an initial interruption of normal retinal development at the time of preterm birth accompanied by a sudden reduction in insulin-like growth factor-1 (IGF-1) and Vascular Endothelial Growth Factor (VEGF) induces vaso-obliteration followed by second phase of ROP at 32-34 weeks Post-menstrual Age (PMA) characterized by increased hypoxia of the avascular retina [13,14]
Pediatric ophthalmologists comprised 82.4% (n = 220), retinal specialists 8.2% (n = 26), and the remaining 7.6% (n = 21) of respondent physicians identified themselves as general ophthalmologists, dual trained pediatric/retinal specialists and neuro-ophthalmologists. 40.4% (n = 108) physicians were in practice for more than 16 years and the remaining ranged from < 2 years to15 years
Summary
Retinopathy Of Prematurity (ROP) is the second leading cause of blindness in infants in the United States and is an important source of childhood visual impairment worldwide [1,2,3]. Incidence and severity is associated with younger gestational age and lower birth weights [4,5]. This condition is relevant in developed nations in which advances in neonatal care have increased survival of immature infants. Vascular Endothelial Growth Factor (VEGF) is an important growth factor involved in normal retinal vascular development and development of ROP. Current models suggest a biphasic process in which an initial interruption of normal retinal development at the time of preterm birth accompanied by a sudden reduction in insulin-like growth factor-1 (IGF-1) and VEGF induces vaso-obliteration followed by second phase of ROP at 32-34 weeks Post-menstrual Age (PMA) characterized by increased hypoxia of the avascular retina [13,14]. IGF-1 regulates the neovascularization within this stage by acting as an amplifying factor for VEGF [13]
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