Screening Protocol for Retinopathy of Prematurity Lacks Efficiency

Patients who meet only a single criterion for ROP have low rates of diagnosis, suggesting a need to refine screening protocols.

The screening protocol for retinopathy of prematurity (ROP) in preterm births may require reassessment, as patients who meet only 1 criterion have low rates of disease, according to a paper presented at the American Society of Retina Specialists meeting, held in Seattle, July 28 to August 1, 2023. Fewer than 5% of participants who had only a single criterion developed ROP, and none displayed stage 3, zone 1, or plus disease.

Researcher Nimesh Patel, MD, who specializes in adult and pediatric retinal disease at Massachusetts Eye & Ear at Harvard Medical School, reviewed 3 groups of preterm infants to determine the efficiency of the current ROP screening protocol.

Group 1 included patients with birth weights (BW) lighter than 1500 g and gestational ages (GA) of 30 weeks or younger. Group 2 consisted of patients with BW of 1500 g or heavier and GAs less than 30 weeks. Group 3 included those with a BW of 1500 g or heavier and GAs of 30 weeks or more. 

All participants who met inclusion criteria (N=1612) were evaluated for demographic information, zone, stage of ROP, presence of plus disease, tunica vasculosa lentis, and treatment required. They underwent standard ROP screening protocol at the Jackson Memorial Hospital (JMH) Neonatal Intensive Care Unit (NICU) between 2009 and 2020.

We propose a possible algorithm (TWO-ROP) in appropriate NICUs, with an amendment in screening protocol for this low-risk population…

The number of patients diagnosed with ROP was 20 (4.29%) in group 1, 1 (4.35%) in group 2, and 12 (1.07%) in group 3, (P <.001). Patients in group 1 had a mean age of 35.88 weeks at ROP diagnosis. Groups 2 and 3 were 35.7 weeks and 35.29 weeks (range 33.6 – 37.1), respectively (P = .77). 

The mean interval between birth and ROP diagnosis was 36.25 days (range, 12–75 days) for those in group 1, 47 days for group 2, and 23.33 days (range 10-39) for participants in group 3 (P = .05). 

None of the participants met the criteria for treatment, nor were any instances of stage 3, zone 1 or plus disease identified in these patients.

“We propose a possible algorithm (TWO-ROP) in appropriate NICUs, with an amendment in screening protocol for this low-risk population to include only an outpatient screening exam within 1 week of discharge, or at 40 weeks if inpatient, to decrease the inpatient ROP screening burden while maintaining safety,” Dr Patel explained.  


Patel N. Retinopathy of prematurity outcomes of neonates meeting only a single screening criterion: proposal of the TWO-ROP algorithm. Paper presented at: American Society of Retinal Specialists (ASRS) 41st Annual Meeting; July 28-August 1, 2023; Seattle.