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Retinopathy of prematurity comes full circle
  1. Alistair R Fielder1,
  2. Graham E Quinn2,
  3. Parag K Shah3,
  4. Brian A Darlow4,
  5. Neil Marlow5
  1. 1 City, University of London, London, UK
  2. 2 University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3 Department of Pediatric Retina, Ocular Oncology Aravind Eye Hospital, Coimbatore, Tamilnadu, India
  4. 4 Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
  5. 5 Institute for Womens Health, University College London, London, UK
  1. Correspondence to Professor Alistair R Fielder, City, University of London, London, UK; a.fielder{at}

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In the 70 years since the first description, retinopathy of prematurity (ROP) has been the focus of intensive basic and clinical research. Over time, worldwide, there have been several phenotypes of ROP described. Here, we explore whether these are part of a single spectrum or are separate and distinct entities.

First described in 1942 by Terry, clinical1 and experimental studies2 3 provided compelling evidence that ‘retrolental fibroplasia’—as ROP was then known—was related to uncontrolled oxygen exposure, although some acknowledged that the mechanism was likely complex. This led clinicians to the restriction of supplemental oxygen concentrations to less than 40%, with predictions that this would eliminate an important cause of infant blindness. Sadly, such forecasts were not fulfilled, and ROP-induced blindness still occurred. Subsequently with increasing preterm survival, the population developing ROP had ever decreasing gestational age. Other risk factors for ROP were recognised, leading to the notion that ROP ‘cannot always be prevented’4—a view which prevailed for several decades.

The classification of retrolental fibroplasia published in 19535 did not describe features of early acute ROP, likely due to limitations from the use of the direct ophthalmoscope. The three iterations of the International Classification of Retinopathy of Prematurity (ICROP) of 1984, 2005 and 2021 (for all, see Chiang et al)6 describe ROP in far more detail and have changed clinical practice worldwide. ICROP facilitated a number of clinical studies and trials documenting which forms of ROP will regress spontaneously and which will likely require intervention, together with indications for treatment. …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.