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Richard A. Saunders, MD; Margaret L. Donahue, MD; Linda M. Christmann, MD; Al V. Pakalnis, MD; Betty Tung, MS; Robert J. Hardy, PhD; Dale L. Phelps, MD; Cryotherapy for Retinopathy of Prematurity Cooperative Group

Arch Ophthalmol. 1997;115(5):604-608.

Abstract
Objectives
To determine and compare the incidence of severe, vision-threatening retinopathy of prematurity (ROP) in black and white low-birth-weight infants.

Design
Prospective cohort study.

Setting
Seventy neonatal intensive care units in 23 US participating centers in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity.

Patients
A total of 4099 premature infants weighing less than 1251 g at birth were enrolled to evaluate the natural history of ROP. This 'Natural History' cohort included 2158 white infants and 1584 black infants who were followed up prospectively according to a Natural History protocol.

Main Outcome Measures
Incidence and severity of acute ROP.

Results
While ROP occurred with similar frequency in all racial subgroups, severe ROP was less common in black infants. One hundred sixty (7.4%) of 2158 white infants reached threshold ROP (defined as at least 5 contiguous or 8 cumulative clock-hours of stage 3 retinopathy in zone 1 or zone 2 in the presence of "plus disease" [dilation and tortuosity of the posterior pole blood vessels]), but only 51(3.2%) of 1584 black infants progressed to threshold ROP. Using multiple logistic regression analysis, race emerged as a highly significant factor (P<.001) in the development of threshold disease, even when birth weight, gestational age status at delivery, sex, multiple births, and transport status were considered.

Conclusions
Severe, vision-threatening ROP occurs with greater frequency in low-birth-weight white infants than in low-birth-weight black infants who are seemingly at equivalent risk. The reason for this disparity is unknown. We speculate that differences in retinal pigmentation may confer relative protection against free radical-mediated phototoxic injury in black infants.

Author Affiliations
From the N. Edgar Miles Center for Pediatric Ophthalmology, Department of Ophthalmology (Dr Saunders) and the Department of Pediatrics (Dr Donahue), Medical University of South Carolina, Charleston; the Department of Ophthalmology, University of South Carolina School of Medicine, Columbia (Drs Christmann and Pakalnis); the Coordinating Center for Clinical Trials, School of Public Health, University of Texas, Houston (Dr Hardy and Ms Tung); and the Departments of Pediatrics and Ophthalmology, Children's Hospital at Strong, Rochester, NY (Dr Phelps). A complete listing of the members of the Cryotherapy for Retinopathy of Prematurity Cooperative Group was published previously (Arch Ophthalmol. 1996;114:417-424).

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