Retinopathy of Prematurity: Practical Clinical Approach

Abstract

After completing this article, readers should be able to: 1. Describe the forms that should be used to record all retinopathy of prematurity (ROP) screening examinations. 2. Characterize the roles of ophthalmologists and neonatologists in developing local screening policies. 3. Delineate which preterm infants require screening for ROP and when the first screening examination should occur. 4. Describe the procedure for laser therapy to treat ROP and postsurgical follow-up. The neonatologist and neonatal intensive care unit (NICU) staff have a serious responsibility to minimize vision loss from retinopathy of prematurity (ROP). It requires a team effort throughout the hospitalization to reduce the incidence and severity of ROP and particularly conscientious tracking of patients during the phase of active disease to detect and treat the few cases that become severe enough to threaten retinal detachment. It is particularly frustrating in this most visual of diseases that the pathology occurs inside the eye where the threat is not visible and at the particular time when the infants are recovering from so many other insults and are nearly ready for home! Among infants of similar gestations, those who have the more unstable hospital course have the higher risk of serious ROP. It is important to remember that interventions that prolong pregnancy and reduce intraventricular hemorrhage, pneumothorax, serious sepsis, and chronic lung disease all reduce the risk of vision-threatening ROP. To date it is impossible to prevent all morbidities, but each year brings increased knowledge about how to reduce their incidence and hopefully the incidence of severe ROP. An effective ROP screening program requires the cooperative efforts of the neonatal team, screening ophthalmologists, and discharge coordinators. Unlike many screening programs in which the “screening test” is inexpensive, the time and effort of ophthalmologists is considerable in this program, and rarely are their consulting fees paid. Participating in ROP …