Retinopathy of prematurity: guidelines for screening and treatment. The report of a Joint Working Party of The Royal College of Ophthalmologists and the British Association of Perinatal Medicine

Abstract

Following the report that severe retinopathy of prematurity (ROP) can be treated effectively, a working party of the Royal College of Ophthalmologists and the British Association of Perinatal Medicine was convened in 1990 to draw up guidelines for screening [1]. These have been revised by a reconvened working party (Appendix D) and the document expanded to include other relevant issues such as the practicalities of treatment, counselling and end-stage retinopathy. Screening is recommended for all babies at risk of severe ROP, i.e. those of birth weight < or = 1500 g and or < or = 31 weeks gestational age. The aim of screening is to identify severe ROP (stage 3) which may require treatment, or, in a baby due to be discharged to home or to another hospital, any ROP which has the potential to become severe. The first examination should be between 6 and 7 weeks postnatal age, and subsequent examinations continued until vascularisation has progressed into zone 3 when the risk of stage 3 ROP has passed. As the window of time available for treatment is very short, examinations should be undertaken every 2 weeks. Treatment is currently undertaken when threshold stage has been reached. Threshold ROP is defined as: Stage 3 ROP: involving five or more contiguous or eight or more cumulative clock hours; in the presence of congestion of the posterior pole vessels--'plus' disease. Treatment can be by cryotherapy or laser in the neonatal unit. Parents have a right to know what may befall their baby, and it is important to provide balanced information, and this should be given to parents of babies: at risk of developing any ROP; who are close to or have severe disease or requiring treatment; blinded by ROP. Despite meticulous clinical care, babies are occasionally blinded by ROP. That is not the end of the road and there is still work for the clinician to do: counsel on the role of vitrectomy; manage the disorganised anterior segment; initiate and actively participate in the care of the visually impaired child. The screening and management should be undertaken or supervised by senior ophthalmologists with a specific interest in this condition. It is recommended that one or two consultants in each area should gain expertise and supervise training. Referencing here is not exhaustive with preference being given to recent reviews. With certain exceptions citations are at the commencement of each section rather than at specific issues.