Retinopathy Of Prematurity In India Research Articles

Retinopathy of prematurity in India - what can we learn from the polio legacy?

Retinopathy of prematurity (ROP) is a vasoproliferative disease of the preterm retina that has the potential to cause vision impairment and blindness. Timely screening and treatment are hence critical for infants at risk for ROP. Screening for ROP is challenging in India owing to the limited resources, a vast at-risk population and lack of awareness among paediatricians and the public. Addressing ROP in India requires a comprehensive approach involving multiple sectors, considering the magnitude of the problem and the expected increase in need for ROP services due to the increased survival of preterm infants following improvements in neonatal care. The success of the Global Polio Eradication Initiative (GPEI) offers valuable lessons for improving ROP services in developing nations by applying its strategies. An approach for primary and secondary prevention of ROP is proposed, and the current challenges and a neonatal-led care model for ROP are discussed.

Operational guidelines for ROP in India: A summary.

Retinopathy of Prematurity (ROP) is a potentially blinding disease of the eye that can affect infants born four or more weeks preterm and have received intensive neonatal care. ROP is a dynamic, time-bound disease that is not present at birth. Preventing visual loss from ROP in India requires scaling up services for screening and treatment for ROP to match the exponential growth in neonatal intensive care in India and other low- and middle-income countries. Operational guidelines for prevention of visual loss from ROP will facilitate rapid scale up of services, by identifying key players and their roles and responsibility in the Indian context. The guidelines recommend broad eligibility criteria for screening (gestational age ≤34 weeks, birth weight ≤2000 gms) as the special newborn care unit (SNCU) have varying quality of neonatal care. Treatment is based on the early treatment for retinopathy of prematurity (ET-ROP) study treatment criteria. The screening criteria could be revisited when more contextual evidence on the risk of ROP is available in India.

Retinopathy of prematurity: Addressing the emerging burden in developing countries.

Retinopathy of prematurity has emerged and continues to be one of the leading causes of avoidable childhood blindness in low- and middle-income countries over the past few years. A major reason is the lack of adoption of effective and efficient screening for retinopathy of prematurity in various neonatal or newborn units across the countries. At the same time, there is an improvement in the survival rate of high-risk newborn babies which causes a further rise in retinopathy of prematurity. Most of the associated risk factors for retinopathy of prematurity are avoidable, therefore, various preventive strategies can be developed at various levels of healthcare facilities ranging from primary to tertiary level. The integration of appropriate retinopathy of prematurity intervention programs between healthcare departments and partnerships with other non-governmental eye care institutions would be an important as well as critical step to prevent blindness and visual impairment due to retinopathy of prematurity in India and other developing nations.

Retinopathy of prematurity in India: incidence, risk factors, outcome and the applicability of current screening criteria

Background: To study the incidence, risk factors and outcome of retinopathy of prematurity (ROP) in at-risk newborns at tertiary care hospital in Vadodara.Methods: Preterm infants with birth weight ≤2000 gm and gestation ≤34 weeks were screened for ROP at 4 weeks of birth for first screening or if <28 week or <1200 grams then at 3 weeks after delivery. Infants with birth weight >2000 gm and gestation >34 weeks were screened only if they had additional risk factors. Those found to have high risk ROP were treated.Results: The incidence of ROP in 286 infants who were screened was 24.1%, 12 ROP positive cases were having birth weight >2000 gm. On multivariate analysis risk factors predisposing to ROP (P<0.05) were birth asphyxia, Sepsis, multiple blood transfusion, respiratory distress syndrome, multiple birth, antenatal steroid use and Phototherapy. Out of 69 infants who developed ROP, 6(8.7%) needed invasive management.Conclusions: Risk factors predisposing to ROP were gestational age and birth weight alone and along with the various risk factors like birth asphyxia, sepsis, multiple blood transfusion, respiratory distress syndrome, multiple birth, antenatal steroid use and phototherapy. The occurrence of ROP is trending towards a rise including newborns with higher birth weight and gestational age in developing countries; hence necessitating to use different guideline for Screening of Newborns in these developing countries.

The current state of retinopathy of prematurity in India, Kenya, Mexico, Nigeria, Philippines, Romania, Thailand, and Venezuela.

Retinopathy of prematurity (ROP) is one of the leading causes of preventable blindness in children worldwide. Middle-income nations are currently experiencing epidemic levels of ROP, because greater access to neonatal intensive care units has improved survival rates of premature infants, but without sophisticated oxygen regulation. The epidemiology, screening infrastructure, treatment options, and challenges that these countries face are often tied to unique local socioeconomic, cultural, geopolitical, and medical factors. We present an overview and narratives of the current state of ROP in eight countries that are or soon will be experiencing ROP epidemics-India, Kenya, Mexico, Nigeria, Phillipines, Romania, Thailand, and Venezuela-with a view to fostering both an understanding of the differences in the ROP landscape in various settings and an interest in the further development of ROP screening and treatment services tailored to local requirements.

Changing patterns of early childhood blinding conditions presenting to a tertiary eye center: The epidemic of retinopathy of prematurity in India

Purpose:Retinopathy of prematurity (ROP) is now emerging as one of the major causes of preventable childhood blindness. The proportion of preterm babies has increased dramatically over the past decade. Our study aims to emphasize the need for ROP screening and management services in these preterm infants.Methods:ICD-coded medical records of children less than 10 years of age presenting to a subspecialty eye hospital from 2000 to 2017 were reviewed. ROP, congenital cataract, congenital glaucoma, and vitamin A deficiency were the most common diagnoses. We evaluated the trend of these diseases from 2000 to 2017.Results:Our data suggested a 20-fold increase in the attendance of children with a diagnosis of ROP who now make over 2% of outpatient children. Vitamin A deficiency has declined over time whereas cataract and glaucoma have remained stable.Conclusion:Our data indicate a need to scale up ROP screening integrated with neonatal care, as well as to build capacity for the treatment of acute and late-stage ROP in India.

Retinopathy of Prematurity

Retinopathy of Prematurity (ROP) is a bilateral proliferative retinopathy affecting premature infants with low birth weight who have been exposed to high concentration of oxygen. The retinopathy was first reported by Terry in 1942. ROP can be seen in 85% to 90% of children of low birth weight when exposed to high concentration of oxygen. The incidence of ROP in India varies between 39-51.9% in low birth weight infants. When excessive oxygenation is used in the nursing of premature infants, ex-utero changes in oxygen tension causes abnormal up or down-regulation of VEGF expression. Dysregulated VEGF expression leads to untimely vasoobliteration 9 or exaggerated vasoproliferation. Retinal arteries and eventually the veins are obliterated inciting a phase neovascularisation and fibrous proliferation resulting in different stages of ROP. The ultimate goals of treatment of threshold ROP are prevention of any retinal detachment or scarring and Optimization of visual outcome Laser has become the instrument of choice. The aim of the treatment is to ablate the entire peripheral avascular retina up to the ora serrata in a near confluent burn pattern .Surgery for stage 4B ROP is performed to minimize retinal distortion and prevent total detachment .The functional goal is ambulatory vision. The collaborative effort involving the paediatrician, neonatologist and the ophthalmologist is required to prevent this preventable cause of blindness in children. Failure to diagnose and treat ROP and its complications in a timely fashion increases the legal exposure of physicians caring for children with ROP

A mobile team for screening of retinopathy of prematurity in India: Cost - effectiveness, outcomes, and impact assessment

PURPOSE:To study the cost effectiveness, outcomes and impact of retinopathy of prematurity (ROP) screening and management model for urban neonatal intensive care units (NICUs).STUDY DESIGN:Public health intervention study.METHODS:This study was conducted in 2013. Staff of a mobile unit assessed all infants aged less than 34 weeks of Gestation age at birth and/or birth weight 1700 GM or less admitted in five NICUs between 2013 and 2015. A trained ophthalmologist performed bedside ROP screening through dilated pupils using indirect ophthalmoscope. ROP was graded and managed as per the International Classification of Retinopathy of Prematurity treatment guidelines. Counseling and laser treatment were the interventions. The incidence, grade and determinants of ROP were estimated. Direct and indirect costs were calculated to estimate the unit cost of screening and managing a child with ROP using the model.RESULTS:The study sample included 102 preterm/underweight infants. The prevalence of ROP of different grades in either eye was 32% (95% Confidence Intervals (CI): 23.2–41.5). ROP stage I was present in 75% of these eyes. The model could help in preventing/reducing visual disability in 4 infants with advanced stages of ROP. The unit cost of ROP screening, identifying one child with ROP and addressing visual disability due to ROP was US $ 198.9, 596.7 and 4,137.4 respectively.CONCLUSION:A mobile screening is likely feasible and cost-effective method to detect ROP and offer timely intervention for NICU in urban areas with limited resources.

Impact of expansion of telemedicine screening for retinopathy of prematurity in India.

Purpose:The purpose of this study is to estimate the unknown burden of retinopathy of prematurity (ROP) blindness from nine states of India using demographic, incidence and treatment data from an ongoing statewide ROP program in Karnataka called the Karnataka Internet Assisted Diagnosis of ROP (KIDROP) and to calculate the fiscal quantum of preventable blindness in these states.Materials and Methods:The KIDROP model is an ongoing tele-ROP service providing screening and treatment for ROP in Karnataka since 2008. Using this index strategy, an impact assessment in nine other states was constructed, the number of potential blind babies enumerated, the fiscal quantum of blindness prevented in blind person-years (BPYs), and the increase in burden with improving survival and institutional deliveries calculated.Results:The total population in the ten study states is 681.5 million. The eligible babies for ROP screening annually are 467,664. The number of babies admitted to neonatal units is 188,561 of which 160,277 are likely to survive and require screening. Based on KIDROP data, ROP would develop in 35,886 of these infants, and 1281 babies would require treatment annually. The fiscal quantum of BPY saved in these ten states is USD 108.4 million annually, with a further increase of USD 106.8 million with improving infant survival and higher admission rates for delivery.Conclusion:A KIDROP like model can provide ROP screening in low-resource settings, remote centers, and regions with few ROP specialists. Expanding the model to other states with similar demographics can prevent over USD 100 million of blindness burden annually.

Modification of Screening Criteria for Retinopathy of Prematurity in India and Other Middle-Income Countries

To determine the gestational age and birth weight of premature babies who developed vision-threatening severe retinopathy of prematurity. Prospective observational study of babies at risk of blindness due to retinopathy of prematurity. Data pertaining to all babies who underwent laser treatment or surgery for acute retinopathy of prematurity and those who had cicatricial retinopathy of prematurity were prospectively collected. The gestational age and birth weight were evaluated to establish screening criteria. In 120 babies, the mean gestational age was 29.6 weeks (range 26 to 36 weeks). The birth weight of 115 babies ranged from 710 to 2000 g (mean 1254.5 g, SD 280.8). Birth weight was not available for five babies. Only one baby had a gestational age of >35 weeks. Ocular morbidity related to retinopathy of prematurity was seen in bigger and more mature babies. This study provides a scientific basis for establishing screening criteria for retinopathy of prematurity in South India and other middle-income countries.