Guidelines Summary

Retinopathy of Prematurity (ROP) Screening Examination Guidelines (2018)

Guidelines on the screening of preterm infants for ROP were released on November 26, 2018, by the American Academy of Pediatrics (AAP).^{[47, 48]}These guidelines are summarized below.

Infants should be screened for ROP on the basis of birth weight (≤1500 g), gestational age (30 weeks or less), and risk for ROP (eg, infants with hypotension or those who received oxygen supplementation). Some at-risk infants with a birth weight from 1500 g to 2000 g should also be screened.

Retinal screening examinations using binocular indirect ophthalmoscopy after pupillary dilation should be used to detect ROP.

Remote photographic screening for ROP may initially be used instead of binocular indirect ophthalmoscope examinations before treatment is indicated.

Perform indirect ophthalmoscopy before treatment or termination of acute-phase screening for at-risk infants.

The presence of plus disease (two or more quadrants of the retina affected by abnormal dilatation and tortuosity of the posterior retinal blood vessels) indicates treatment instead of observation.

Intravitreal injection of anti–vascular endothelial growth factor (anti-VEGF) agents (eg, bevacizumab injection) may be used as a treatment for aggressive posterior ROP.

Longer follow-up should be employed after anti-VEGF treatment, as it is often associated with a later recurrence of ROP when relative to conventional laser peripheral retinal ablative treatment.

Specific unit criteria for the management of ROP should be established for each neonatal intensive care unit in agreement with both the neonatology and ophthalmology services.

Ophthalmologic follow-up and transition of care should be arranged before the infant is discharged, including the necessary follow-up eye-examinations and the schedule for these examinations.

Infants who are develop subthreshhold ROP are at higher risk of visual disorders (strabismus, amblyopia, high refractive errors, cataracts, and glaucoma). Follow-up with a pediatric ophthalmologists 4 to 6 months after discharge is necessary to assess visual function and to address any issues (see "Long Term Monitoring" in the Treatment section).

For more information, go to Retinopathy of Prematurity Ophthalmologic Approach.

Medication

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Media Gallery

Retinopathy of Prematurity. Stage I retinopathy of prematurity.
Retinopathy of Prematurity. Scheme of retina of right eye (RE) and left eye (LE) showing zone borders and clock hours used to describe location and extent of retinopathy of prematurity.
Retinopathy of Prematurity. Zone I retinopathy of prematurity.
Retinopathy of Prematurity. Zone II retinopathy of prematurity.
Retinopathy of Prematurity. Zone III retinopathy of prematurity.
Retinopathy of Prematurity. Stage II retinopathy of prematurity.
Retinopathy of Prematurity. Stage III retinopathy of prematurity.
Retinopathy of Prematurity. Mild extraretinal fibrovascular proliferation.
Retinopathy of Prematurity. Moderate extraretinal fibrovascular proliferation.
Retinopathy of Prematurity. Severe extraretinal fibrovascular proliferation.
Retinopathy of Prematurity. A comparison between attached and detached retina.
Retinopathy of Prematurity. Retinopathy of prematurity (ROP) threshold, according to the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Cooperative Group.
Retinopathy of Prematurity. Treatment guidelines, according to the Early Treatment for Retinopathy of Prematurity (ET-ROP) study.
Retinopathy of Prematurity. Laser photocoagulation. RPE = retinal pigment epithelium.
Retinopathy of Prematurity. Cryotherapy probe application.

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Author

Siva Subramanian, MD, FAAP Emeritus Chief of Neonatal-Perinatal Medicine, Medstar Georgetown University Hospital; Professor Emeritus of Pediatrics and Obstetrics, Senior Ethicist, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center

Siva Subramanian, MD, FAAP is a member of the following medical societies: American Pediatric Society, American Association for the Advancement of Science, American College of Nutrition, American Pediatric Society, American Society for Parenteral and Enteral Nutrition, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Melissa D Kern, MD Owner and Ophthalmologist in Pediatric and Adolescent Ophthalmology and Adult Strabismus, Arlington-Loudon Pediatric Ophthalmology; Chief of Surgery (Ophthalmology), Virginia Hospital Center

Melissa D Kern, MD is a member of the following medical societies: Northern Virginia Academy of Ophthalmology

Disclosure: Nothing to disclose.

William F Deegan, III, MD Associate Clinical Professor of Ophthalmology, Georgetown University School of Medicine; Attending Surgeon, Spectrum Retina and Ocular Oncology, Virginia Hospital Center Health System

William F Deegan, III, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, Massachusetts Medical Society, Washington Academy of Eye Physicians and Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Arun K Pramanik, MD, MBBS Professor of Pediatrics, Louisiana State University Health Sciences Center

Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Santina A Zanelli, MD Associate Professor, Department of Pediatrics, Division of Neonatology, University of Virginia Health System

Santina A Zanelli, MD is a member of the following medical societies: American Academy of Pediatrics, American Epilepsy Society, Society for Neuroscience, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Oussama Itani, MD, FAAP, FACN Clinical Associate Professor of Pediatrics and Human Development, Michigan State University; Medical Director, Department of Neonatology, Borgess Medical Center

Oussama Itani, MD, FAAP, FACN is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, American Heart Association, American College of Nutrition

Disclosure: Nothing to disclose.

Monisha Bahri, MBBS, MD Attending Physician, Department of Neonatalogy, Washington Hospital Center

Monisha Bahri, MBBS, MD is a member of the following medical societies: American Academy of Pediatrics, Medical Council of India, Indian Academy of Pediatrics

Disclosure: Nothing to disclose.

Gonzalo (Vike) Vicente, MD, FAAP Consulting Ophthalmologist, Eye Doctors of Washington

Gonzalo (Vike) Vicente, MD, FAAP is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American Medical Association

Disclosure: Nothing to disclose.

Gestational Age at Birth (wk)	Chronologic Age (wk)	Postmenstrual Age (wk)
22^*	9	31
23^*	8	31
24	7	31
25	6	31
26	5	31
27	4	31
28	4	32
29	4	33
30	4	34
31 (if necessary)	4	35
32 (if necessary)	4	36

Retinopathy of Prematurity Guidelines

Guidelines Summary

Retinopathy of Prematurity (ROP) Screening Examination Guidelines (2018)

References

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