How soon after discharge do you see an infant who had stage 1 or 2 ROP but reached near complete vascularization and was improving as expected without treatment?

Issue: January 25, 2012

Follow until full vascularization

Michael F. Chiang

I follow infants with ROP until they vascularize fully. Because of data showing that premature infants do have higher incidence of eye disease in childhood, I’ll generally see these children every 6 to 12 months, at least until they can do good visual acuity testing in the office. Then I will often have them follow up with the pediatrician if there are no ocular concerns. So in practice, that usually means I follow them until age 3 to 5 years. In general, I find that it is fairly rare that I stop examining infants regularly, in other words every 2 weeks or even every week, before they reach full term.

Michael F. Chiang, MD, is from Oregon Health & Science University, Portland, Oregon. Disclosure: Dr. Chiang receives funding from the National Institutes of Health (grant EY 19474) and is an unpaid member of the Scientific Advisory Board for Clarity Medical Systems (Pleasanton, Calif.).

Vascularization must fully reach ora serrata temporally

Steven J. Lichtenstein

If I see a baby twice in the hospital before discharge and their retinal vessels are stage 1 or 2, with progression into zone III, but not completely vascularized, I see them in my office in 2 weeks. If they are stage 3, I will see them in 1 week, or sooner, depending on how they are vascularizing. I continue to see them until they’re completely vascularized on the same follow-up schedule as if they were still in the hospital. I don’t release them for an extended period of time until they are fully vascularized to the ora serrata temporally. Once they’ve reached completion, if I’m not seeing other problems, I see them back in 6 months and I will check the refraction at that time. I’m also looking at their postmenstrual age. If I have an infant with two examinations at zone III and who is 42 or 44 weeks’ postmenstrual age, that’s different than if the infant is going to be discharged at 35 weeks’ postmenstrual age and I still haven’t seen complete vascularization.

Steven J. Lichtenstein, MD, is from University of Illinois College of Medicine at Peoria and Chicago, Illinois Eye Center, Peoria, Illinois. Disclosure: Dr. Lichtenstein is a consultant for, has received funding from, and is on the speaker’s bureau for Alcon Laboratories.

Adapted from Eye to Eye. J Pediatr Ophthalmol Strabismus. 2011;48(6):328-332.