Retinopathy of Prematurity Guidelines

Updated: Feb 10, 2023
  • Author: Siva Subramanian, MD, FAAP; Chief Editor: Santina A Zanelli, MD  more...
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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.