Retinopathy of prematurity in India - what can we learn from the polio legacy?

Abstract

Retinopathy of prematurity (ROP) is a vasoproliferative disease of the preterm retina that has the potential to cause vision impairment and blindness. Timely screening and treatment are hence critical for infants at risk for ROP. Screening for ROP is challenging in India owing to the limited resources, a vast at-risk population and lack of awareness among paediatricians and the public. Addressing ROP in India requires a comprehensive approach involving multiple sectors, considering the magnitude of the problem and the expected increase in need for ROP services due to the increased survival of preterm infants following improvements in neonatal care. The success of the Global Polio Eradication Initiative (GPEI) offers valuable lessons for improving ROP services in developing nations by applying its strategies. An approach for primary and secondary prevention of ROP is proposed, and the current challenges and a neonatal-led care model for ROP are discussed.

Keywords: Global polio eradication initiative; Key performance indicators; Retinopathy of prematurity; Screening; Surveillance.

Fig. 1

An overview of retinopathy of prematurity surveillance with regular reporting. To improve the accuracy of ROP incidence rates and facilitate timely interventions for at-risk infants, ROP screening programs could adopt a polio surveillance-style model that requires regular reporting of every eligible infant’s ROP screening outcome, including submitting regular ‘zero reports’ when no ROP cases are detected.

Fig. 2

Key performance indicators related to retinopathy of prematurity surveillance.

Fig. 3

A schematic representation of the process of preventing retinopathy of prematurity using a relay race analogy. Each subspecialist takes over from the previous one, similar to how a swimmer hand over the baton to their teammate in a relay race. The obstetrician initiates the process in the antenatal period by optimizing fetal development and prolonging gestation. The paediatrician takes over by identifying and reducing risk factors, screening (inhouse) in some instances and referring at-risk infants to ophthalmologists. Finally, the ophthalmologist takes over the baton, devising and implementing the treatment plan and providing ongoing follow-up care. Collaboration and communication between subspecialists are critical for the successful prevention and management of ROP.