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Brief Report
November 2, 2017

Posterior Pole Vascular Changes Before Treatment of Retinopathy of Prematurity

Author Affiliations
  • 1Department of Ophthalmology, Duke University, Durham, North Carolina
JAMA Ophthalmol. Published online November 2, 2017. doi:10.1001/jamaophthalmol.2017.4608
Key Points

Question  When an infant was determined to need treatment for retinopathy of prematurity, what vascular characteristics were present, and how many days passed from the last examination when vessels were normal bilaterally?

Findings  In this study of 55 infants treated for retinopathy of prematurity, when a decision was made to treat, all but 1 infant had preplus or plus disease, and at least 7 days had passed since the vessels were noted to be normal in 54 infants.

Meaning  These findings suggest that when imaging to screen for retinopathy of prematurity if the field of view includes all of zone I and imaging is performed weekly, imaging is unlikely to miss retinopathy of prematurity that requires treatment.

Abstract

Importance  Some proponents of telemedicine screening for retinopathy of prematurity (ROP) believe that a screening system based on the characteristics of posterior pole vessels is sufficient for identifying infants needing treatment.

Objective  To evaluate the vascular characteristics present when treatment was determined to be needed and the number of days from the last examination when the vessels of both eyes were noted to be normal until a decision was made to treat.

Design, Setting, and Participants  This retrospective study included all infants who underwent longitudinal examination and treatment for ROP in the neonatal intensive care unit at an academic medical center, Duke University, from June 22, 2013, through May 2, 2017.

Main Outcomes and Measures  Vascular characteristics present on clinical examination when an infant was determined to need treatment and the number of days from the last examination when the vessels of both eyes were noted to be normal until a decision was made to treat.

Results  Fifty-five infants (30 male and 25 female) met eligibility criteria, with a mean birthweight of 733 g (range, 420-1060 g), mean gestational age of 25.1 weeks (range, 22.9-27.7 weeks), and mean postmenstrual age when a decision was made to treat of 36.7 weeks (range, 31.4-43.0 weeks). When an infant was determined to need treatment, 51 (93%) had plus disease; 3 (5%), preplus disease; and 1 (2%), neither. The number of days from the last examination when an infant was noted to have normal vessels bilaterally until a decision was made to treat ranged from 0 to 49 days. The interval was at least 14 days for 42 infants (76%) and at least 7 days for all but 1 infant (98%). The exception was an infant with the rare scenario of neither preplus nor plus disease with zone I, stage 3 ROP (type 1 ROP) at the time when the examiner decided to treat.

Conclusions and Relevance  At the time when infants were determined to need treatment for ROP, all but 1 had preplus or plus disease. These results suggest that narrow-field imaging for ROP screening should include all of zone I to identify the rare treatment-requiring ROP with normal posterior pole vessels. If confirmed, with sufficient image quality, weekly photographic screening of zone I likely should capture changes indicative of impending ROP requiring treatment.

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