Variations in medical practice of retinopathy of prematurity among 8 Asian countries from an international survey

Abstract

Advances in perinatal care have led to the increased survival of preterm infants with subsequent neonatal morbidities, such as retinopathy of prematurity (ROP). This study aims to compare the differences of neonatal healthcare systems, resources, and clinical practice concerning ROP in Asia with review of current literature. An on-line survey at the institutional level was sent to the directors of 336 neonatal intensive care units (NICU) in 8 collaborating national neonatal networks through the Asian Neonatal Network Collaboration (AsianNeo). ROP screening was performed in infants born at < 34 weeks in Indonesia and Japan. In South Korea, Malaysia, and Taiwan, most screened for ROP in infants born at < 32 weeks. In all networks, majority of NICUs conducted ROP screening to infants with birth weight < 1500 g. In most NICU's in-hospital ophthalmologists performed indirect ophthalmoscopy and some were supplemented with digital imaging. Both laser photocoagulation and anti-vascular endothelial growth factor injection are performed for treatment and, vitreous surgeries are conducted less frequently in all countries. Despite limited information collected by the survey, this first study to compare ROP practices implemented in eight Asian countries through AsianNeo will enable an understanding of the differences and facilitate quality improvement by sharing better practices.

Figure 1

ROP screening criteria in the eight AsianNeo Countries. (A) The screening criteria of gestational age for ROP. (B) The screening criteria of birth weight. GA gestational age, IDN Indonesia, JPN Japan, KOR South Korea, MYS Malaysia, NA not available, PHL Philippines, SGP Singapore, TWN Taiwan, THA Thailand.

Figure 2

The way of initial eye examination for ROP screening in the eight AsianNeo Countries. (A) Screening person. (B) Screening method. BIO bilateral indirect ophthalmoscopy, IDN Indonesia, JPN Japan, KOR South Korea, MYS Malaysia, NA not available, PHL Philippines, SGP Singapore, TWN Taiwan, THA Thailand.

Figure 3

Treatment strategies of ROP in the eight AsianNeo Countries. The left column is about the laser photocoagulation, the middle is about the anti-VEGF injection, and the right column is the result of the vitrectomy. (A) Indonesia (n = 38); (B) Japan (n = 144); (C) South Korea (n = 13); (D) Malaysia (n = 35); (E) Philippines (n = 16); F, Singapore (n = 3); (G) Taipei (n = 25); (H) Thailand (n = 62). IDN Indonesia, JPN Japan, KOR South Korea, MYS Malaysia, NA not available, PHL Philippines, SGP Singapore, TWN Taiwan, THA Thailand, VEGF vascular endothelial growth factor;