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March 1, 2005

The Dilemma of Exercising Clinical Judgment in the Treatment of Retinopathy of Prematurity

Arch Ophthalmol. 2005;123(3):408-409. doi:10.1001/archopht.123.3.408

The Early Treatment for Retinopathy of Prematurity (ETROP) study1 has demonstrated an incremental improvement in the structural (9.1% vs 15.6%) and functional (14.5% vs 19.5%) success rate of eyes treated during a narrowly defined prethreshold state. This study identified children with type 1 prethreshold retinopathy of prematurity (ROP) as benefiting from earlier intervention with peripheral ablative therapy. Type 1 prethreshold was defined as (1) zone I, any stage ROP with plus disease; (2) zone I, stage 3 ROP without plus disease; or (3) zone II, stage 2 or 3 ROP with plus disease. Using this algorithm for all infants will significantly increase the number of unnecessary treatments administered since many eyes will spontaneously involute without treatment. We have recently found ourselves in a dilemma when screening children for ROP and suspect that other physicians who screen for ROP have experienced similar issues highlighted by the child described herein.