Retinopathy Of Prematurity Services Research Articles

Impact of COVID-19 pandemic on retinopathy of prematurity services in low resource settings.

Retinopathy of prematurity is an increasingly important cause of blindness in children in low- and middle-income countries. Timely screening and treatment greatly reduce blindness. This study assessed the impact of the COVID-19 pandemic on ROP services in low- and middle-income countries. An online survey with closed and open-ended questions in Microsoft Teams was sent to 304 ophthalmologists providing screening, treatment and/or vitreoretinal services (January 15 to March 12 2021). Categories were used to report impact on services. 28 participants were purposively selected for interview. 184/201 completed forms from 32 countries were received. Two thirds of participants worked in government facilities and 45.6% were paediatric ophthalmologists. A moderate to severe impact was reported by 13% for screening, 9% for treatment and 16% for vitreoretinal surgery with some variation between government, private and not-for-profit sectors. 22% thought services would take a year to recover. Fifteen ophthalmologists from 12 countries were interviewed. Many reported fewer neonatal admissions, and several reported more ROP blind infants once restrictions lifted. Themes associated with services continuing included limited lockdown, autonomy and flexibility, commitment, advocacy and technology. Themes associated with a negative impact include fear and panic, closure of facilities, COVID infection or quarantining of health workers and parents, lack of transport and exacerbation of poverty. The COVID pandemic had a very variable impact on the provision of ROP services. In some countries where the impact was great, more infants may have become blind from ROP. Lessons can be learnt for planning pandemic preparedness.

Reducing the Impact of the COVID-19 Pandemic on Retinopathy of Prematurity Screening: Successful Strategies Learnt from a Multi-Center Tele-Medicine Program in India

ABSTRACT Purpose Control of blindness due to retinopathy of prematurity (ROP) requires timely screening and treatment within 48–72 h. Anticipating that the coronavirus disease 2019 (COVID-19) pandemic would disrupt ROP services, we devised strategies '‘on-the'’-go”” to ameliorate this possiblity. We describe the successful outcomes of this approach in preventing infant blindness during the pandemic. Methods Data on the number of preemies recruited, screened and treated in the Karnataka Internet-assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program were collected in a retrospective (2019, interval 1) – prospective (2020, interval 2) manner. We summarize 10 key strategies that were developed as we faced logistic, operational and implementation challenges. These included pragmatic methods of enhancing enrolment, transporting for screening and ensuring timely treatment in the outreach. Results The total number of ROP screening sessions was 20,598 (7,197 new) and 14,371 (5,773 new) during interval 1 and 2 respectively. Of these, 166 (2.3%) and 157 (2.7%) infants required treatment during interval 1 and 2 respectively. All infants needing treatment during the COVID period, were treated on time which was possible due to successful implementation of the ‘on-the-go’ strategies throughout the state of Karnataka. The fiscal equivalent of the blindness prevented during this period is USD 15.6 million. Conclusion The greater decline in the number of ROP screening episodes in neonatal units in government hospitals was because several were converted to ‘COVID only” hospitals. KIDROP’s multi-zonal, decentralized strategy, which uses non-physician-based imaging in a telemedicine network, ensured that essential ROP services continued even during the lockdown.

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.

Impact of COVID-19 Pandemic on Retinopathy of Prematurity Services in the Indian Public Healthcare System.

To analyze the impact of the COVID-19 pandemic on the retinopathy of prematurity (ROP) services at Special Newborn Care Units (SNCUs), which provide care for sick neonates in the Indian public healthcare system. A retrospective chart analysis of 508 babies screened for ROP at two SNCUs in West Bengal (India). We compared the data from the lockdown period (April, 2020-June, 2020; study arm) with the same period of the preceding year, 2019 (control arm). Out of the 508 babies, 187 were screened during the lockdown and 328 during 2019. The odds of developing ROP were 2.08 times (95% CI:1.25-3.48; P=0.002) higher during the lockdown period (35/187 babies; 18.72%) as compared to the previous year (34/328 babies; 10.37%). Also, the risk of sight-threatening ROP (ST-ROP) increased significantly during the lockdown (12/35 ROP babies; 34.29%) compared to the previous year (4/34 ROP babies; 11.76%) (odds ratio: 3.9; 95% CI:1.1-13.7; P=0.015). Notably, all babies with ROP during the lockdown presented more than 30 days after birth, compared to none in the previous year. All babies requiring laser therapy recovered completely in both groups. An increased odds of developing ROP, including ST-ROP, was observed during the COVID-19 pandemic. Delayed ROP screening, which was noted in all study eyes, can have a detrimental effect on long-term visual prognosis. The findings of our research call for modifying the present healthy policy framework to make it more adaptable to disruptions in healthcare services, given the cyclical nature of the worldwide COVID-19 pandemic.

Premature infants with gestational age less than 25 weeks require increased ophthalmology resources for retinopathy of prematurity

It is unclear how increasing survival of low gestational age (GA) infants affects ophthalmologic screening and treatment rates for retinopathy of prematurity (ROP). This study compared the examination and treatment rates of infants born at GA of <25 weeks and those born at GA of at least 25 weeks. This was a retrospective study of patients who met institutional ROP screening criteria and were admitted to two neonatal intensive care units (NICUs) from January 2017 to June 2020. Variables analyzed were GA, birth weight, number of ophthalmology examinations, worst stage of ROP, presence of type 1 ROP, and comorbidities associated with ROP. The χ2, Fisher exact, and two-tailed t tests, as well as univariate and multivariable logistic regression, were used for statistical analysis. Compared to the GA≥25 group, the GA<25 group had a higher number of total exams (10 vs 4.3 [P < 0.001]), higher average worst stage of ROP (1.4 vs 0.3 [P < 0.001]) and higher rate of type 1 ROP (21% vs 1.4% [P < 0.001]), as well as higher mortality (37% vs 8.11% [P < 0. 001]). Multivariable logistic regression analysis controlling for GA, sepsis, and number of transfusions revealed that only GA was significantly associated with developing type 1 ROP. Infants with GA <25 weeks had more severe ROP and required significantly more ophthalmologic examinations than GA ≥25. It is important for ROP services to plan for this increased screening load, especially if the number of such lower-weight infants in their NICUs increases.

The time and financial ramifications of providing services for retinopathy of prematurity at a single inner-city institution in the United States: a pilot study

Retinopathy of prematurity (ROP) is a sight-threatening disease that requires strict, scheduled screening and timely treatment. Examining infants in the neonatal intensive care unit (NICU) confers an added burden for ophthalmologists whose practices are predominantly outpatient. We sought to evaluate the time required for ROP services and to approximate compensation to better understand the implications of providing this crucial service. The ROP coordinator tracked the time ophthalmologists spent providing ROP services at two NICUs (2018-2020). Estimated revenue was calculated using Medicaid Current Procedural Terminology codes. Total ophthalmologist time was from NICU arrival to departure; travel time was estimated as 45 minutes. The ophthalmologists cumulatively spent on average 98 and 108 hours yearly for screening only (SO) and screening plus treatment (ST), respectively; this increased to 164 and 181 hours yearly with travel time, respectively. Estimated annual Medicaid physician reimbursements were $15,246 ($156/hour) for SO and $19,184 for ST ($177/hour). Actual annual physician reimbursements were $39,655 ($405/hour) for SO and $53,385 for ST ($492/hour). With travel time, reimbursements decreased by about 40%. A hypothetical full-time ROP practice would generate annual physician salaries of $204,732 for SO and $232,807 for ST. With travel time, this decreases to $122,452 and $139,379, respectively. Performing ROP services requires substantial time, especially when including travel among facilities. This study highlights the extensive requirements for the critical task of decreasing ROP blindness.

Editorial introductions

Editorial introductions

Socioeconomics of retinopathy of prematurity screening and treatment in the United States

Retinopathy of prematurity (ROP) screening, an integral part of pediatric ophthalmology, can be time consuming and resource intensive. The purpose of this study was to evaluate the economic landscape of ROP screening and treatment among pediatric ophthalmologists in the United States.An online survey was distributed to US pediatric ophthalmologists through a pediatric ophthalmology email listserv. Survey results were compiled, and responses were deidentified and analyzed, with particular focus on factors affecting financial compensation.A total of 97 responses were collected. Almost half of respondents worked in private practice settings. Over 80% of respondents had a formal contract to perform ROP care, but only 26% enlisted the assistance of an attorney to negotiate their contract. Just over half of respondents believed themselves adequately compensated for their services. Respondents that had retained an attorney for contractual negotiations were more likely to have a higher mean annual compensation rate ($126,545 ± $145,133 vs $70,214 ± $50,671; P = 0.05). Physicians who believed themselves adequately compensated were more likely to be in academic practice settings (78% academic vs 55% combo/other vs 24% private; P < 0.001) and were more likely to have contracts to perform ROP care (68% with contracts vs 15% without; P = 0.001). Average annual compensation was $82,968 ± $84,132, approximately $24,000 higher than reported in 2013.More pediatric ophthalmologists among our respondents obtained contracts for their services, and compensation rates have increased since 2013. Nevertheless, concerns regarding under-compensation and time commitment persist, raising concerns about the long-term sustainability of current models for providing ROP services.

Retinopathy of prematurity: Overview and highlights of an initiative to integrate prevention, screening, and management into the public health system in India.

Purpose:In India, more than 800 special newborn care units (SNCUs) have been established since 2008 in government facilities. More preterm infants are now surviving and blindness from retinopathy of prematurity (ROP) is increasing. The aim of the Queen Elizabeth Diamond Jubilee Trust's initiative (2012–1019) was to improve the quality of neonatal care and integrate ROP services into the government health system using expertise in the government and nongovernment sector in four states in a sustainable and scalable manner.Methods:State Ministries of Health were engaged and collaboration was established between three government programs (Ministry of Health and Family Welfare, Rashtriya Bal Swasthya Karyakram, and blindness prevention) and relevant professionals. Extensive training took place and equipment was provided. Implementation was guided by a multidisciplinary National Task Force and was monitored by state coordination committees. The Task Force appointed technical expert groups to support implementation through advocacy, information, education and communication materials, operational guidelines, a competency-based training curriculum, and an online database and website.Results:Twenty-two ophthalmologists in government facilities were trained to screen for ROP and nine to treat ROP. Almost 13,500 preterm infants were screened in 17 SNCUs and 86% of the 456 infants with sight-threatening ROP were treated. An educational resource using latest pedagogy based on key domain areas for best practices for small and preterm neonates including ROP has been developed and pilot tested and is being evaluated and scaled up.Conclusion:All four states are scaling up services or have plans to scale up, and several other states have started the initiatives.

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

Estimate of incidence of ROP requiring treatment in extreme preterms and impact on service-7 year review in tertiary unit.

Retinopathy of prematurity (ROP) is a potentially blinding disorder affecting premature infants. Our Eye Unit supports two neonatal intensive care units (NICUs), one provides neonatal surgical and medical facilities and the other is exclusively medical. Our objectives were to (1) to identify the annual rate of ROP treatments during the period 2009-2015 and (2) to estimate the incidence of ROP treatment in babies born very prematurely (<27 weeks). Records for all infants treated for ROP by our unit during the period 2009-2015 were reviewed. We calculated numbers treated in each year. Records of babies born under 27 weeks of gestation and cared for in the non-surgical NICU were also reviewed. Their requirement for laser treatments for ROP was calculated by the week of gestation at birth. In the two NICUs combined, 95 infants were treated for ROP between 2009 and 2015. The numbers treated increased from 9/158 (5.7%) of babies screened in 2009 to 22/159 (13.8%) in 2015 (ptrend = 0.004). The rate of laser treatment for ROP increased as gestation at birth decreased: from 12/100 (12%) of babies born at 26 weeks to 17/29 (59%) of babies born at 23 weeks (ptrend = 0.001). The number of laser treatments for ROP carried out by this unit has increased steadily between 2009 and 2015 and this may in part be due to the increased need for ROP treatment in extremely preterm babies, whose survival has increased in the same period. These data may aid planning for ROP services.

Treatment of retinopathy of prematurity in Northern Ireland, 2000-2011: a population-based study.

To evaluate the incidence of treatment-requiring retinopathy of prematurity (ROP) over a 12-year-period in Northern Ireland. The medical records of all infants treated for ROP from January 2000 to December 2011 were retrospectively reviewed and cross-referenced with the Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) database. The Northern Ireland population data showed an increase in the number of live births from 2000 to 2011. The proportion of babies born with a birth weight <1501 g and/or <32 weeks' gestational age remained constant (χ(2) trend = 3.220, P = 0.0727), although the proportion of these babies who died prior to 42 weeks' gestation decreased from 2000 to 2011 (P = 0.0196 using χ(2) for trend = 5.445; P = 0.0354 using χ(2) = 20.809). The prevalence of treatment-requiring ROP in these infants increased from 1.05% in 2000 to 5.78% in 2011 (P < 0.001 using χ(2) trend = 16.309; P < 0.001 using χ(2) = 31.378). The present population-based study highlights that the incidence of treatment- requiring ROP is increasing in Northern Ireland. The increasing number of infants requiring treatment will need to be taken into consideration in the commissioning process for ROP services in Northern Ireland.

The KIDROP model of combining strategies for providing retinopathy of prematurity screening in underserved areas in India using wide-field imaging, tele-medicine, non-physician graders and smart phone reporting.

Aim:To report the Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity (KIDROP) program for retinopathy of prematurity (ROP) screening in underserved rural areas using an indigenously developed tele-ROP model.Materials and Methods:KIDROP currently provides ROP screening and treatment services in three zones and 81 neonatal units in Karnataka, India. Technicians were trained to use a portable Retcam Shuttle (Clarity, USA) and validated against ROP experts performing indirect ophthalmoscopy. An indigenously developed 20-point score (STAT score) graded their ability (Level I to III) to image and decide follow-up based on a three-way algorithm. Images were also uploaded on a secure tele-ROP platform and accessed and reported by remote experts on their smart phones (iPhone, Apple).Results:6339 imaging sessions of 1601 infants were analyzed. A level III technician agreed with 94.3% of all expert decisions. The sensitivity, specificity, positive predictive value and negative predictive value for treatment grade disease were 95.7, 93.2, 81.5 and 98.6 respectively. The kappa for technicians to decide discharge of babies was 0.94 (P < 0.001). Only 0.4% of infants needing treatment were missed. The kappa agreement of experts reporting on the iPhone vs Retcam for treatment requiring and mild ROP were 0.96 and 0.94 (P < 0.001) respectively.Conclusions:This is the first and largest real-world program to employ accredited non-physicians to grade and report ROP. The KIDROP tele-ROP model demonstrates that ROP services can be delivered to the outreach despite lack of specialists and may be useful in other middle-income countries with similar demographics.

Knowledge, Attitude Practice Study of Retinopathy of Prematurity amongst Pediatricians attending a Neonatal Ventilation Workshop in South India

Objectives: To assess the knowledge, attitude and practice patterns (KAP) of pediatricians about retinopathy of prematurity (ROP). Methods: We administered a questionnaire to pediatricians, prior to a talk on ROP, in a neonatology ventilation workshop. Questions included finding information about their educational and practicing profile, knowledge of screening guidelines, risk factors for ROP, referral facilities and barriers for referral. Results: A total of 38 pediatricians participated in the study. The mean age of the participants was 35.83 ± 7.2 years, 86.8% of them were men. All participants (100%) knew about the risk factors for ROP. 97.4% (37/38) of the participants knew about the ROP screening guidelines and 68% (26/38) knew about the laser treatment for ROP. Only 29% (11/38) knew the composition of dilating drops to be used for preterm babies and 53% (20/38) had an established referral program for ROP. The barriers for ROP screening expressed by pediatricians, included ‘parents not willing’, by 7/38 of the participants(18.4%); 'unaware of referral facilities' by 6/38 of the participants (15.8%) and ‘too expensive’ by 5/38 of the participants (13.1%). Regarding barriers for ROP screening, ‘parents not willing’ reason was expressed by 18.4% (7/38), ‘unaware of referral facilities’ by 15.8% (6/38) and ‘too expensive’ by 13.1% (5/38) of the participants. Conclusions: The study findings suggest that a large majority of pediatricians at a neonatology ventilation workshop were aware of the science of ROP but had less information of ROP service delivery and treatment modalities. The study suggests the need for creating awareness and close coordination between pediatricians and ophthalmologists to address the barriers for screening and service delivery for ROP. This will facilitate taking the science from books and journals to the bedside of the premature neonates and help in reducing needless blindness due to untreated ROP.

Socioeconomics of Retinopathy of Prematurity In-Hospital Care

To determine if there was any uniform experience across the United States relative to retinopathy of prematurity (ROP) services provided, reimbursement, and malpractice insurance coverage. An online pediatric ophthalmology listserv poll queried pediatric ophthalmologists regarding ROP screening, reimbursement, malpractice insurance, and call and consult coverage. Compensation for providing ROP services is quite variable around the United States. The Southern respondents reported the highest contract income while the Northeast reported the lowest. The mean annual contract income was $63 753 and the median annual contract income was $39 000. There was an even distribution between physicians vs hospitals providing malpractice coverage. There was also a fairly even distribution between physicians who do and do not provide consult and call coverage. Nationwide, there is no standard rate of compensation for ROP in-hospital care, coverage of liability insurance, or providing additional consult or on-call services. Income generation performing ROP screening examinations is roughly half what a pediatric ophthalmologist can generate by seeing patients in the clinic or performing surgery.

The Retinopathy of Prematurity Screening Examination: Ensuring a Safe and Efficient Examination While Minimizing Infant Discomfort

Retinopathy of prematurity (ROP) examinations in the NICU are necessary to protect vision in premature infants, but the examinations are associated with risk and discomfort. ROP examination risks include adverse effects from mydriatic agents, systemic responses to the stress of examination, and nosocomial infection. Infant discomfort may be lessened by limiting examination length and possibly by measures such as topical anesthetic, oral sucrose, and certain nonpharmacologic techniques. A well-organized ROP service facilitates appropriate scheduling of examinations and education of the infant's parents. This article addresses causes of risk and infant discomfort, providing a framework for developing a safe and efficient ROP service while minimizing infant discomfort.

Retinopathy of prematurity in the UK I: the organisation of services for screening and treatment.

To ascertain how closely services for the screening and treatment of retinopathy of prematurity (ROP) were organised on a national level in 1995. Questionnaires about the local arrangements for the screening and treatment of retinopathy of prematurity (ROP) were sent to the entire consultant membership (n = 648) of the Royal College of Ophthalmologists (RCOphth) and to the clinical directors (n = 259) of neonatal units and other units caring for preterm babies in the UK in 1995. 568/648 of UK consultants (88%) and 15 non-consultant ophthalmologists and 210/259 paediatricians (81%) and 19% paediatricians in non-neonatal units responded. Thirty-one per cent responding ophthalmologists were involved in the ROP service: of these 64% screened babies, 34% screened and treated babies, while 1% ophthalmologists treated ROP but did not screen. Ninety-six per cent units caring for preterm babies had their babies screened for ROP and for almost 95% of the screening took place in the neonatal unit. About 8200 babies were screened in 1994; 277 developed stage 3, of whom 54% received treatment. Nine per cent (n = 14) and 5% (n = 8) treated babies became blind in one and both eyes respectively. A sessional commitment was identified for 9% ophthalmologists, but for less than half this was included in the contracted work programme. Sixty-five ophthalmologists treated babies with ROP, but only 10 treated more than five babies in 1994. Training needs were identified by 71 respondents. Several aspects of ROP screening and treatment services require improvement. Hopefully, reducing the number of identified screeners would increase skills, confidence and the ability to recognise severe disease requiring treatment, and also facilitate incorporation of this work into consultant work plans.