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Screening for retinopathy of prematurity: does one size fit all?
  1. Clare E Gilbert
  1. Correspondence to Dr Clare Gilbert, International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; clare.gilbert{at}Lshtm.ac.uk

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The epidemic of blindness from retinopathy of prematurity (ROP) is spreading and is now affecting countries in Asia and the Pacific region as well as Latin America and Eastern Europe. An estimated 32 300 infants became blind or visually impaired from ROP in the year 2010, with the largest number being in the East and Southeast Asia and Pacific region.1 The spread of the epidemic is due to several factors, the most important being the welcomed expansion of services for sick and preterm newborns in emerging economies, particularly in the large populations in Asia and the Pacific, which has led to greater survival of preterm infants. Unfortunately, policies and programmes for the detection and treatment of ROP have not always kept pace with the expansion of neonatal care.

It has been recognised for almost two decades that sight-threatening ROP can affect more mature infants in settings where levels of neonatal care are suboptimal, and this is reflected in variation in the criteria for ROP screening in national guidelines (figure 1). All the guidelines represented in figure 1 were developed or have been revised since 2004 and were based on local evidence. All countries with very high levels of development, based on the United Nation's Human Development Index, have criteria that fall within a gestational age (GA) of ≤32 weeks or a birth weight (BW) of ≤1500 g, including Sweden, which uses only one criterion of GA of <31 weeks. Countries with lower development indices tend to use wider criteria, reflecting the population at risk.

Figure 1

Gestational age and birthweight indications for screening for retinopathy of prematurity in different countries.

Countries that have not yet developed evidence-based criteria need to adopt wider BW and GA criteria than anticipated …

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