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Potential for a paradigm change in the detection of retinopathy of prematurity requiring treatment
  1. Clare Gilbert1,
  2. Richard Wormald2,
  3. Alistair Fielder3,
  4. Ashok Deorari4,
  5. Luz Consuelo Zepeda-Romero5,
  6. Graham Quinn6,
  7. Anand Vinekar7,
  8. Andrea Zin8,
  9. Brian Darlow9
  1. 1Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Cochrane Eyes and Vision Group, London School of Hygiene & Tropical Medicine, London, UK
  3. 3Division of Optometry & Visual Science, City University, London, UK
  4. 4Department of Neonatology, All India Institute of Medical Sciences, Delhi, India
  5. 5Department of Ophthalmology, Hospital Civil de Guadalajara, Guadalajara, Mexico
  6. 6Division of Ophthalmology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
  7. 7Department of Pediatric Retina, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
  8. 8Department of Clinical Research, Child and Maternal Health, Instituto Fernandes Figueira, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
  9. 9Department of Paediatrics, University of Otago, Christchurch, New Zealand
  1. Correspondence to Dr Clare Gilbert, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK; clare.gilbert{at}

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The increasing incidence of blindness due to retinopathy of prematurity

Retinopathy of prematurity (ROP) is a major cause of potentially avoidable blindness in children in the middle-income countries of Latin America and Eastern Europe, and is becoming a public health problem in Asia.1 Indeed, the earlier estimate that there were 50 000–60 000 children worldwide who were blind from ROP2 is a marked underestimate, as a recent systematic review suggests that annually 20 000 infants (uncertainty range 15 500–27 200) became blind or severely visually impairment from ROP worldwide in 2010, with a further 12 300 (8300–18 400) being visually impaired.3 Asia has the highest number, reflecting the rapid expansion of services for preterm infants in the region.4 ,5 The rate of severe visual loss from ROP is 1.8–2.6 times higher per million births in East Asia, the Pacific region, Latin America and Eastern Europe than in high-income countries, reflecting both a higher incidence of severe ROP and inadequate detection and treatment.

The recognition that prematurity is a major cause of infant and under five mortality rates6 is leading to rapid expansion of neonatal care in many countries such as India,7 China and Russia, which will put an increasing number of infants at risk of ROP. Visual loss from ROP will continue to increase in low-income and middle-income countries with improving preterm survival rates unless there are dramatic improvements in neonatal care coupled with higher coverage of high-quality services for the detection and treatment of ROP.

Programmes for ROP in low-income and middle-income countries

The vast majority of programmes for the detection and treatment of ROP rely on highly skilled ophthalmologists who visit neonatal units on a weekly basis, or more frequently, to examine infants at risk. Many middle-income countries have criteria for examination, often drawn up collaboratively by professional societies of ophthalmologists and neonatologists, and programmes are becoming integrated into health systems. Many use criteria based on …

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