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New ROP screening guidelines present timely subject for AAPOS meeting

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KEYSTONE, Colo. — Recently released guidelines for screening infants with retinopathy of prematurity generated much discussion here at the meeting of the American Association for Pediatric Ophthalmology and Strabismus.

Both on and off the podium, the new guidelines had attendees talking about how their current ROP screening practices will be affected.

Jointly promulgated by the American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics, the guidelines were published in the February issue of Pediatrics.

The main change is that the guidelines now recommend that all infants born between 28 and 32 weeks gestation should be initially screened at 4 weeks after birth. Previously, the guidelines recommended initial screening between 4 and 6 weeks, and the decision was somewhat discretionary depending on considerations such as the local incidence of the disease.

In general, all infants born earlier than 32 weeks gestation and small babies who are born after this gestational mark must be screened for ROP.

For subsequent examinations, the new guidelines outline a screening schedule based on the infant’s gestational and chronologic age to detect ROP before it presents a risk for retinal detachment.

The new guidelines also incorporate the findings of the Early Treatment for Retinopathy of Prematurity Randomized Trial (ETROP), published in Archives of Ophthalmology in December 2003. The ETROP study found significant advantages to early, aggressive treatment of high-risk, prethreshold ROP.

While many practitioners have already adopted the ETROP findings on their own, the new guidelines in effect codify them, making them standard of care.

Both the revised and original guidelines can be found in their entirety on Pediatrics’ Web site, http://pediatrics.aappublications.org.

The subject generated some controversy during a round table discussion organized by Ocular Surgery News during the AAPOS meeting. Look for this as well as complete coverage of the guidelines’ implications in upcoming issues of Ocular Surgery News.