Proposals given for ROP detection and treatment

San Francisco-The American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Academy of Pediatrics released a series of recommendations on which to base effective detection and treatment of retinopathy of prematurity (ROP). The groups discuss improvements in the possible treatment of ROP and the importance of carefully timed retinal exams by an ophthalmologist for at-risk premature infants.

The groups add that the overall goal of the screening program should be to identify the premature infants who require treatment for ROP from among the larger population of at-risk infants, while limiting exams as much as possible.

"Recent developments in peripheral retinal ablative therapy using laser photocoagulation, and demonstration of their efficacy, have resulted in the possibility of markedly decreasing the incidence of poor visual outcome," explained Walter M. Fierson, MD, chairperson, American Academy of Pediatrics Retinopathy of Prematurity Subcommittee.

The Multicenter Trial Cryotherapy for Retinopathy of Prematurity's 10-year follow-up report showed effectiveness of peripheral retinal cryotherapy in reducing unfavorable outcomes from 48% to 27% in structural outcomes and 62% to 44% in unfavorable visual outcomes.

The recommendations include a table to help practitioners better determine the timing of the first eye examination. The table is based on gestational age at the time of birth rather than chronological age.

"Determining the infant's gestational age gives us a much more accurate assessment of when the child should be examined, as the youngest infants at birth take the longest time to develop serious ROP," said Michael X. Repka, MD, president, the American Association of Pediatric Ophthalmology and Strabismus, and member of the statement review committee.

"The table provides a schedule for detecting ROP before it becomes severe enough to miss the optimum time for ablative therapy, while at the same time minimizing the number of potentially traumatic examinations," Dr. Repka added.

The recommendations suggest that efforts should be made to reduce the discomfort and systemic effect of examinations by pre-treating the infant's eyes with a topical anesthetic agent, such as proparacaine, and by using pacifiers, oral sucrose, and other soothing methods.

The recommendations are an update to a statement made previously in 2001.