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Uniform care may minimize extensive number of exams in infants with ROP
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Establishing uniform care for infants with retinopathy of prematurity may alleviate the number of unnecessary examinations that are performed, a physician said in a presentation at the American Association for Pediatric Ophthalmology and Strabismus annual meeting in New Orleans.
“While protocols exist for evaluation of ROP, actual physician practice may vary,” Amanda L. Way, MD, said in her delivery of results of a Web-based survey of 267 physician respondents who related their preferences for ROP treatment.
The 22-question survey was administered to determine preferences and trends in treatment, as well as to determine screening and examination patterns in the management of ROP. The survey was sent to members of the AAPOS, the American Society of Retina Specialists and the World Society of Paediatric Ophthalmology and Strabismus.
Questions pertained to treatment preferences, postmenstrual age of infants at the conclusion of screening exams, incidence of late recurrence or retinal detachment, and number of specialists who perform laser photocoagulation or intravitreal injections.
Treatment guidelines do exist; for example, the American Academy of Pediatrics created a policy statement of revised guidelines for the treatment of preterm infants with ROP. AAP guidelines recommend that serial examinations in infants with ROP not requiring treatment can be concluded at a postmenstrual age of 50 weeks. In the survey, more than 53% of respondents said they would continue examinations after 50 weeks or until outpatient examination was no longer feasible, Way said.
Additionally, 7% of physicians would perform prophylactic laser photocoagulation before the infant’s discharge. Seventeen percent did not choose any of the preferences for exam conclusion options, with many suggesting evaluations be made case by case.
“There is a small portion who pursue prophylactic laser prior to conclusion, and while this may not necessarily be standard of care in all infants, it may serve as a promising modality to its subsets,” Way said.
The AAP guidelines suggest that an infant with posterior zone 1 disease may be treated with intravitreal Avastin (bevacizumab, Genentech). In the survey, 46% of respondents preferred intravitreal bevacizumab as primary first-line therapy, while 37% preferred laser therapy and 17% preferred dual therapy.
The AAP guidelines also suggest that infants treated with bevacizumab be monitored weekly until retinal vascularization is complete. In the survey, more than half of respondents said that they monitor infants every 2 weeks, and a quarter elect for monthly follow-up, ranging from 50 to 80 weeks after injection, Way said.
With concurrent intravitreal and laser photocoagulation dual therapy, there was a similar trend in a 2- to 4-week follow-up until retinal vascularization is completed. In this cohort, a wide range of respondents said they would conduct additional retinal evaluations, but a majority said they would conclude at 50 weeks, Way said.
Of the physicians who perform treatments in their practices, 46% said they would perform their own laser therapy, while 33% would perform their own bevacizumab injections, Way said.
Way said that the survey highlights a low competency of physicians performing laser therapy and injections in this setting, while follow-up examinations can be overly extensive. – by Kristie L. Kahl
- For more information:
- Amanda L. Way, MD, can be reached at University of Pittsburgh School of Medicine, Eye & Ear Institute, 203 Lothrop St., Suite 800, Pittsburgh, PA 15213; email: wayal@upmc.edu.
Disclosure: Way reports no relevant financial disclosures.