Retinopathy Of Prematurity Care Research Articles

Non-contact smartphone-based fundus imaging compared to conventional fundus imaging: a low-cost alternative for retinopathy of prematurity screening and documentation

Retinopathy of prematurity (ROP) is a frequent cause of treatable childhood blindness. The current dependency of telemedicine-based ROP screening on cost-intensive equipment does not meet the needs in economically disadvantaged regions. Smartphone-based fundus imaging (SBFI) allows for affordable and mobile fundus examination and, therefore, could facilitate cost-effective telemedicine-based ROP screening in low-resources settings. We compared non-contact SBFI and conventional contact fundus imaging (CFI) in terms of feasibility for ROP screening and documentation. Twenty-six eyes were imaged with both SBFI and CFI. Field-of-view was smaller (ratio of diameters, 1:2.5), level of detail was equal, and examination time was longer for SBFI as compared to CFI (109.0 ± 57.8 vs. 75.9 ± 36.3 seconds, p < 0.01). Good agreement with clinical evaluation by indirect funduscopy was achieved for assessment of plus disease and ROP stage for both SBFI (squared Cohen’s kappa, 0.88 and 0.81, respectively) and CFI (0.86 and 0.93). Likewise, sensitivity/specificity for detection of plus disease and ROP was high for both SBFI (90%/100% and 88%/93%, respectively) and CFI (80%/100% and 100%/96%). SBFI is a non-contact and low-cost alternative to CFI for ROP screening and documentation that has the potential to considerably improve ROP care in middle- and low-resources settings.

Retinopathy of prematurity campaign in Bangladesh: Experience and lessons learnt

Retinopathy of Prematurity (ROP) is a potentially avoidable cause of irreversible blindness or severe visual impairment in many infants born premature. The global incidence of premature birth has been reported to be 11.1 per 100 livebirths in 2010. The present communication share the experience and lessons learnt during a Neonatologist-Ophthalmologist Retinopathy of Prematurity (NO-ROP) campaign and ROP situation analysis in Bangladesh. A weeklong workshop was organised in May 2016 in Dhaka for the paediatricians and ophthalmologists of the country involved in ROP care. This included a programme to train the attendees on basic to advanced ROP care. Finally, a half day session was organised for the government stakeholders, non government organisations, obstetricians, neonatal and child health care providers and ophthalmologists to assess the level of awareness, the gaps and any obstacles for an effective ROP care in the country. Besides, two neonatal units were visited to assess the ROP situation at district levels in Bangladesh. The observations were documented and recommendations suggested. The awareness and resource availability for ROP care was disproportionately less compared to the demand even in Dhaka. At the district levels, the ROP care mostly did not exist. However, the eagerness to help, support and bridge the gaps was tremendous both among the government and non government organisations. There is an urgent need to strengthen and expand the existing ROP services in Dhaka as well as at the district levels. The observations made and lessons learnt could go a long way in combating ROP blindness in Bangladesh and in other developing countries.&#x0D; Bangladesh Med Res Counc Bull 2019; 45: 122-125

Monitoring Disease Progression With a Quantitative Severity Scale for Retinopathy of Prematurity Using Deep Learning

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide, but clinical diagnosis is subjective and qualitative. To describe a quantitative ROP severity score derived using a deep learning algorithm designed to evaluate plus disease and to assess its utility for objectively monitoring ROP progression. This retrospective cohort study included images from 5255 clinical examinations of 871 premature infants who met the ROP screening criteria of the Imaging and Informatics in ROP (i-ROP) Consortium, which comprises 9 tertiary care centers in North America, from July 1, 2011, to December 31, 2016. Data analysis was performed from July 2017 to May 2018. A deep learning algorithm was used to assign a continuous ROP vascular severity score from 1 (most normal) to 9 (most severe) at each examination based on a single posterior photograph compared with a reference standard diagnosis (RSD) simplified into 4 categories: no ROP, mild ROP, type 2 ROP or pre-plus disease, or type 1 ROP. Disease course was assessed longitudinally across multiple examinations for all patients. Mean ROP vascular severity score progression over time compared with the RSD. A total of 5255 clinical examinations from 871 infants (mean [SD] gestational age, 27.0 [2.0] weeks; 493 [56.6%] male; mean [SD] birth weight, 949 [271] g) were analyzed. The median severity scores for each category were as follows: 1.1 (interquartile range [IQR], 1.0-1.5) (no ROP), 1.5 (IQR, 1.1-3.4) (mild ROP), 4.6 (IQR, 2.4-5.3) (type 2 and pre-plus), and 7.5 (IQR, 5.0-8.7) (treatment-requiring ROP) (P < .001). When the long-term differences in the median severity scores across time between the eyes progressing to treatment and those who did not eventually require treatment were compared, the median score was higher in the treatment group by 0.06 at 30 to 32 weeks, 0.75 at 32 to 34 weeks, 3.56 at 34 to 36 weeks, 3.71 at 36 to 38 weeks, and 3.24 at 38 to 40 weeks postmenstrual age (P < .001 for all comparisons). The findings suggest that the proposed ROP vascular severity score is associated with category of disease at a given point in time and clinical progression of ROP in premature infants. Automated image analysis may be used to quantify clinical disease progression and identify infants at high risk for eventually developing treatment-requiring ROP. This finding has implications for quality and delivery of ROP care and for future approaches to disease classification.

Habilitation services for children blind from retinopathy of prematurity: Health care professionals' perspective in Maharashtra.

Purpose:To explore the knowledge of retinopathy of prematurity (ROP) and habilitation services for children with visual loss from ROP, among health care professionals (HCPs) involved in care of preterm children and to explore their attitudes and practices in relation to referral for habilitation.Methods:A modified knowledge, attitude and practice questionnaire were administered to ophthalmologists and paediatricians associated with ROP care. Data were collected about their knowledge, beliefs and practices of ROP and referral to rehabilitation facilities. Data were analysed to establish level of knowledge, type of attitude and practices and its association with speciality.Results:Response rate was 78% (25/32). Most (14/25, 56%) were ophthalmologists. All (100%) participants knew that ROP can cause blindness. Knowledge about Indian ROP screening criteria was poor among a third (8/25, 32%), more so in paediatricians (5/11, 45.5%). Most (21/25, 84%) did not have knowledge of what a habilitation service entails and where such facilities are located. More than two-thirds (18/25, 72%) believed that special education should be preferred over inclusive education. Overall, 10/25 (40%) of the HCPs had never referred a child for rehabilitation. More than a half (13/25, 52%) were not confident of counselling parents of blind children. All agreed that rehabilitation services are not part of but should be included in medical curriculum.Conclusion:Indian guidelines for ROP screening are not universally known among HCPs. Educating medical undergraduates, providing counselling training to professionals and integration of rehabilitation into the health system will ensure continuity of care for children with visual loss and their families.

Results of the National Program for the Prevention of Blindness in Childhood by Retinopathy of Prematurity in Argentina (2004-2016).

The ROP Argentina Group was created in 2003 and is responsible for the National Program for the Prevention of Blindness in Childhood by Retinopathy of Prematurity (ROP) in Argentina. To describe the program implementation and results achieved in relation to ROP care in terms of effectiveness, access, and quality (2004-2016). Descriptive, retrospective study with a dynamic cohort carried out in facilities that are part of the registry. Eligible population: All preterm newborn infants with risk factors for ROP. Participating health care services increased from 14 to 98 and covered the 23 provinces and the Autonomous City of Buenos Aires. A total of 956 infants were born with < 1500 g in 2004 and 2739, in 2016. Of these, 22.7 % had some degree of ROP and 7.8 % required treatment (severe ROP). Vision screening exceeded 90 %, and treatments at the place of origin increased (57 %-92 %). The incidence of unusual cases is still high (17.3 % of treated cases), and missed opportunities are still recorded. The use of anti-angiogenic drugs trebled since 2011, when they started to be used. Significant achievements were observed in terms of program representativeness, scope, and adherence, and also in relation to screening access and treatment at the place of origin; however, the incidence of ROP is still high. The persistence of unusual cases and missed opportunities evidences deficiencies in the quality of health care and outpatient followup and underlines the need to strengthen the program actions in relation to services.

Preferences and Trends in Practices Caring Premature Infants for Retinopathy of Prematurity (ROP): A Web-based Survey

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 &gt; 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 &gt;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 &gt; 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

Toward Achieving 100% Adherence for Retinopathy of Prematurity Screening Guidelines.

To report on the use of a cloud-based electronic medical record (ROP Check; Glacier Medical Software, Anchorage, AK) designed to provide American Academy of Pediatrics (AAP) guideline-adherent retinopathy of prematurity (ROP) care through the scheduling and documenting of ROP examinations. Data analysis on 3,155 patients from a de-identified dataset from 13 neonatal intensive care units. All newborns with a gestational age of 22 to 30 weeks (N = 2,278) were entered with a documented ROP examination. Of those, 98% and 97.4% completed their initial and follow-up examinations, respectively, within AAP guidelines. All but 1 of 145 initial treatments were completed within AAP guidelines after a decision for treatment was made. Of 369 newborns older than 30 weeks' gestational age and with a birth weight of less than 1,500 grams, none progressed to treatment; four patients had stage 2 or 3 ROP. Of 508 newborns with a gestational age of 31 to 32 weeks and a birth weight of more than 1,500 grams who were entered to identify unstable newborns, 34% did not need examinations; of those who were examined, one progressed to treatment. Fourteen percent of patients were observed as outpatients before retinal maturity and 12% missed some or all outpatient appointments. A decision was made to treat at the first examination for 2 (10%) newborns with a gestational age of 22 weeks and 2 (2%) newborns with a gestational age of 23 weeks. Each patient was within the AAP guidelines for initial treatment. A computerized system specifically designed with process improvement and error-free delivery of ROP care as a focus can improve adherence to AAP guidelines and achieve superior results. Such a system creates a standardized and measurable safety net for pediatric ophthalmologists, neonatologists, hospitals, and follow-up pediatricians. [J Pediatr Ophthalmol Strabismus. 2017;54(6):356-362.].

Developing contracts and safety nets for retinopathy of prematurity care

Developing contracts and safety nets for retinopathy of prematurity care

Retinopathy of prematurity: screening and treatment in Costa Rica

AimTo determine the recent demographic data, risk factors and results of retinopathy of prematurity (ROP) screening and treatment in Costa Rica.MethodsThe medical records of all preterm infants meeting ROP screening...

Evaluation of Visunex Medical’s PanoCamTM LT and PanoCamTM Pro wide-field imaging systems for the screening of ROP in newborn infants

ABSTRACTIntroduction: Retinopathy of Prematurity (ROP) is a leading cause of childhood blindness. The incidence of ROP is rising, placing greater demands on the healthcare providers that serve these patients and their families. Telemedicine remote digital fundus imaging (TM-RDFI) plays a pivotal role in ROP management, and has allowed for the expansion of ROP care into previously underserved areas.Areas covered: A broad literature review through the pubmed index was undertaken with the goal of summarizing the current state of ROP and guidelines for its screening . Furthermore, all currently used telemedicine remote digital fundus imaging devices were analyzed both via the literature and the companies’ websites/brochures. Finally, the PanoCam LT™ and PanoCam™ Pro created by Visunex Medical were analyzed via the company website/brochures.Expert commentary: The PanoCam LT™ and PanoCam™ Pro have recently been approved for use within the USA and CE marked for international commercialization in European Union and other countries requiring CE mark. These wide-field imaging systems have the intended use of ophthalmic imaging of all newborn babies and meet the requirements for ROP screening, thereby serving as competition within the ROP screening market previously dominated by one camera imaging system.

Telemedicine for evaluation of retinopathy of prematurity.

Retinopathy of prematurity (ROP) remains a significant threat to vision for extremely premature infants despite the availability of therapeutic modalities capable, in most cases, of managing this disorder. It has been shown in many controlled trials that application of therapies at the appropriate time is essential to successful outcomes in premature infants affected by ROP. Bedside binocular indirect ophthalmoscopy has been the standard technique for diagnosis and monitoring of ROP in these patients. However, implementation of routine use of this screening method for at-risk premature infants has presented challenges within our existing care systems, including relative local scarcity of qualified ophthalmologist examiners in some locations and the remote location of some NICUs. Modern technology, including the development of wide-angle ocular digital fundus photography, coupled with the ability to send digital images electronically to remote locations, has led to the development of telemedicine-based remote digital fundus imaging (RDFI-TM) evaluation techniques. These techniques have the potential to allow the diagnosis and monitoring of ROP to occur in lieu of the necessity for some repeated on-site examinations in NICUs. This report reviews the currently available literature on RDFI-TM evaluations for ROP and outlines pertinent practical and risk management considerations that should be used when including RDFI-TM in any new or existing ROP care structure.

Retinopathy of Prematurity: A Nationwide Survey to Evaluate Current Practices and Preferences of Ophthalmologists

To emphasize the demographic and occupational characteristics of ophthalmologists primarily involved in retinopathy of prematurity (ROP) care and to ascertain their practices and preferences. A questionnaire was sent to all Turkish ophthalmologists known to be primarily involved in ROP. They were asked about personal and occupational characteristics, practices and preferences related to ROP care, and for their proposals related to ROP training. Seventy questionnaires were sent, of which 63 (90%) were returned. A total of 44 respondents reported performing laser and 13 vitreoretinal surgery. Preferred treatment was transpupillary laser photocoagulation (54.5%), mostly performed in the operating theater (84.1%) under general anesthesia (72.7%). Only 19 (30.2%) reported intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGF). Ophthalmologists from university hospitals, trained in retina during fellowship, and performing treatment for ROP more commonly performed anti-VEGF injection. Most of them studied ROP after residency and 76.2% think that ROP training during residency is inadequate for clinical practice. This survey reveals considerable variation among Turkish ROP specialists regarding ROP care. The survey data are critical in order to develop quality improvement and help in planning more effective future programs for ROP care in terms of training.

Socioeconomics of Retinopathy of Prematurity Care in the United States

Background and PurposeTo elucidate the experience of pediatric ophthalmologists across the United States who care for infants with retinopathy of prematurity (ROP).MethodsSeven hundred and ten surveys were mailed to U.S. members of the American Association of Pediatric Ophthalmology and Strabismus, and 283 (40%) of 710 surveys were completed. Surveys were reviewed and statistical analysis was completed by the authors.ResultsThere was no uniformity of contract compensation or method for determining the value of ROP care. Almost half of the respondents felt they would generate more income if they did not perform ROP screening. Eighty percent of respondents that were happy with their ROP compensation had a contract for those services. One third of respondents had their malpractice insurance provided by the hospital. Retina specialists performed 40% of inpatient ROP screening and 53% of treatment. Most respondents continued to care for infants with ROP once discharged.ConclusionsIn the United States, there is no uniform experience regarding compensation for ROP care, or a methodology for determining the value of services and coverage of liability insurance. These findings are consistent with previous studies. Lack of uniform compensation and high liability pose a threat to the future of ROP care.

Improving Preterm Ophthalmologic Care in the Era of Accountable Care Organizations

OBJECTIVES To understand retinopathy of prematurity (ROP) follow-up care for preterm very low-birth-weight infants (VLBW; &lt;1500 g) in the context of the chronic care model and identify opportunities for improvement under accountable care organizations. METHODS We conducted focus groups and interviews with parents (N=47) of VLBW infants and interviews with neonatal intensive care unit and ophthalmologic providers (N=28) at 6 sites in Massachusetts and South Carolina. Themes are reported according to consolidated criteria for reporting qualitative research guidelines. RESULTS Respondents perceived that legal liability and low reimbursement contributed to shortages of ROP providers. Some neonatal intensive care units offered subsidies to attract ophthalmologic providers or delayed transfers to institutions that could not provide ROP examinations and/or treatment. Sites used variable practices for coordinating ROP care. Even at sites with a tracking database and a dedicated ROP coordinator, significant time was required to ensure that examinations and treatment occurred as scheduled. Parents' ability to manage their children's health care was limited by parental understanding of ROP, feeling overwhelmed by the infant's care, and unmet needs for resources to address social stressors. CONCLUSIONS Under accountable care organizations, hospitals and ophthalmology practices should share responsibility for ensuring coordinated ROP care to mitigate liability concerns. To promote integrated care, reimbursement for ROP care should be bundled to include screening, diagnosis, treatment, and appropriate follow-up. Clinical information systems should be enhanced to increase efficiency and limit lapses in care. Self-management tools and connections to community resources could help promote families' attendance of follow-up appointments.

Detection of Clinically Significant Retinopathy of Prematurity Using Wide-angle Digital Retinal Photography: A Report by the American Academy of Ophthalmology

To evaluate the accuracy of detecting clinically significant retinopathy of prematurity (ROP) using wide-angle digital retinal photography. Literature searches of PubMed and the Cochrane Library databases were conducted last on December 7, 2010, and yielded 414 unique citations. The authors assessed these 414 citations and marked 82 that potentially met the inclusion criteria. These 82 studies were reviewed in full text; 28 studies met inclusion criteria. The authors extracted from these studies information about study design, interventions, outcomes, and study quality. After data abstraction, 18 were excluded for study deficiencies or because they were superseded by a more recent publication. The methodologist reviewed the remaining 10 studies and assigned ratings of evidence quality; 7 studies were rated level I evidence and 3 studies were rated level III evidence. There is level I evidence from ≥5 studies demonstrating that digital retinal photography has high accuracy for detection of clinically significant ROP. Level III studies have reported high accuracy, without any detectable complications, from real-world operational programs intended to detect clinically significant ROP through remote site interpretation of wide-angle retinal photographs. Wide-angle digital retinal photography has the potential to complement standard ROP care. It may provide advantages through objective documentation of clinical examination findings, improved recognition of disease progression by comparing previous photographs, and the creation of image libraries for education and research. Proprietary or commercial disclosure may be found after the references.

Retinopathy of Prematurity: An Example of a Successful Screening Program

Retinopathy of prematurity (ROP) is a persistent and often devastating morbidity associated with premature and low birth weight infants. It continues to be a frequent diagnosis in the neonatal intensive care unit, despite technologic advances and increased knowledge. The American Academy of Pediatrics (AAP) has issued practice guideline recommendations for ROP screening and treatment that aid in creating a consistent and reliable ROP protocol. Challenges exist in screening for and treating ROP, including delayed or omitted exams, lack of qualified examiners, lack of parental compliance with follow-up care, and fear of litigation. This article provides a detailed example of a successful ROP program based on the AAP recommendations and utilizing a multidisciplinary approach to ensure optimal ROP care for the preterm infant. It also discusses the role of the ROP coordinator assigned to the NICU.

Retinopathy of Prematurity Malpractice Claims

To examine the causes of retinopathy of prematurity (ROP) malpractice claims filed with the Ophthalmic Mutual Insurance Company. All closed ROP malpractice claims were reviewed. Eight cases involved failure of transfer of care on patient discharge from the hospital, 3 cases demonstrated inappropriately long periods between follow-up examinations, 1 case was due to failure of outpatient referral from screening to the treating ophthalmologist, and 1 case concerned unsupervised resident provision of ROP care. Many preventable factors can be addressed to improve ROP care. It is essential to ensure that ophthalmologists, neonatologists, pediatricians, and families are updated on current guidelines for ROP screening and treatment and to facilitate follow-up appointments before patient discharge from the hospital. Doing so can help avoid future malpractice claims and patient harm.

Retinopathy of prematurity care: Patterns of care and workforce analysis

To describe the workforce that provides retinopathy of prematurity (ROP) care. We surveyed a random sample of ophthalmologists' offices by telephone (n = 1504) and then sent a mail survey to those who were reported to provide care to infants (n = 486). Workforce estimates were based on the total number of ophthalmologists in the United States. Thirty percent of ophthalmologists were reported to care for children younger than 1 year of age; 11% of all ophthalmologists examine for (1815; 95% confidence interval [95% CI] 1340-2379) and 6% treat ROP (983, 95% CI 649-1421). ROP examinations are provided by an equal number who have completed fellowship training in pediatric ophthalmology and strabismus (254, 95% CI 182-327) as have not completed any fellowship training (236, 95% CI 163-345). Ophthalmologists with fellowship training in any subspecialty provide 86% of the ROP examinations, with those trained in pediatric ophthalmology providing 50% overall. Some (9%) of the ophthalmologists who examine for ROP, regardless of whether or not they completed a fellowship (p = 0.22), report that their training did not adequately prepare them to do so. In contrast to examinations, most treatment is provided by ophthalmologists who are fellowship trained in retina and vitreous diseases. ROP care is offered by ophthalmologists with different training backgrounds. Future work is needed to understand the relationship between the availability of ophthalmologists and ROP care delivery and the role of new modes of care delivery such as telemedicine.

Barriers To Screening Infants for Retinopathy of Prematurity After Discharge or Transfer From a Neonatal Intensive Care Unit.

Neonatal intensive care unit (NICU) practices may influence the delivery of ophthalmology care for infants eligible for back transfer to a referring community hospital. We conducted this study to assess barriers to screening for Retinopathy of Prematurity (ROP) after discharge or transfer from a NICU.Study Design: Retrospective study of 78 infants who needed ophthalmology examinations at the time of their discharge or transfer from the NICU. These infants either needed screening for ROP or had retinal examinations in the NICU and needed further follow-up.Results: 64% of infants received appropriate eye care. Infants who did not receive the follow-up care had greater mean gestational age (mean SD; 30.7±2.3 vs. 29.4±2.6 weeks, p=0.02) and birth weights (mean SD; 1581±366 vs. 1329±504 gm, p=0.007) compared to infants who received the recommended care. There were no statistical differences between the two groups when comparing their race, maternal age, maternal marital status, insurance coverage, or site of birth. Forty-three (55.1%) infants were transferred back, 26 (33.3%) infants were discharged home from the NICU, while nine (11.6%) infants were discharged home from the regional center after their transfer to the general pediatrics service. Infants discharged from the NICU were significantly more likely to receive recommended eye care compared to infants transported back to the community hospital or transferred to the pediatric service at the regional center (Relative Risk Ratio 1.5, 95% confidence interval 1.1–2.1, p=0.01). Infants transferred or discharged from the NICU not screened for ROP (n=49) had lower completion rates compared to infants who had their first retinal examination in the NICU and needed follow-up (n=29) (89% vs. 49%, p<0.0001). Infants whose ophthalmology follow up was recommended in the discharge summary and had their appointments arranged prior to discharging them from the community hospital or the regional center were ten time more likely to get the appropriate eye care (Relative Risk Ratio 10.7, 95% Confidence Interval 2.8–40.3, p<0.0001) compared to infants who did not have arrangements and recommendations. Parents were compliant (n=56, 89%) with pre-arranged appointments.Conclusions: Infants transferred back or discharged from the NICU before having a retinal examination represent a high-risk group for not receiving eye screening. Scheduling appointments for these infants when they leave the NICU may improve their ROP screening and care.

Retinopathy of prematurity: Lack of association with prenatal care

Objectives: The overall goal of this study was to prospectively assess risk factors for retinopathy of prematurity (ROP) in infants of birth weight <1250 g in an urban population at Bellevue Hospital Center, New York, New York. The hypothesis tested was that lack of prenatal care increases the incidence of ROP. Methods: A consecutive sample of patients admitted to Bellevue Hospital Center's neonatal intensive care unit/special care nursery who weighed <1250 g at birth and survived until their ophthalmology screening examinations were included in the study. The main outcome measures were presence or absence of ROP and prenatal care. Additional relevant clinical information was collected on the patients. Results: Ninety infants were evaluated. Sixty-one (68%) had ROP; 29 (32%) had no ROP. No differences in incidence or severity of ROP were detected with regard to prenatal care when the 2 groups were compared. In this population <1250 g, there were no differences in birth weight or gestational age with respect to prenatal care or lack of prenatal care. Conclusions: Lack of prenatal care was not associated with an increased risk for ROP in infants with birth weight <1250 g in this urban population. (J AAPOS 1999;3:114-6)