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Evidence-Based Screening Criteria for Retinopathy of Prematurity
Natural History Data From the CRYO-ROP and LIGHT-ROP Studies
James D. Reynolds, MD;
Velma Dobson, PhD;
Graham E. Quinn, MD;
Alistair R. Fielder, FRCOphth;
Earl A. Palmer, MD;
Richard A. Saunders, MD;
Robert J. Hardy, PhD;
Dale L. Phelps, MD;
John D. Baker, MD;
Michael T. Trese, MD;
David Schaffer, MD;
Betty Tung, MS;
for the CRYO-ROP and LIGHT-ROP Cooperative Groups
Arch Ophthalmol. 2002;120:1470-1476.
Background The Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) demonstrated the efficacy of treatment for threshold ROP and indicated the need for worldwide ROP screening. Previous guidelines for ROP screening have been largely based on clinical impression; we can now develop evidence-based screening recommendations.
Objective To define the appropriate ages and retinal ophthalmoscopic signs that determine when to commence and conclude acute phase ROP screening.
Design Analysis of data from 2 prospective randomized controlled trials: CRYO-ROP (January 1, 1986, to November 30, 1987) and Light Reduction in ROP (LIGHT-ROP) (July 1, 1995, to March 31, 1997).
Setting Neonatal intensive care units in 23 study centers in the United States for CRYO-ROP and 3 centers for LIGHT-ROP.
Patients Eyes were examined sequentially in 4099 infants with birth weight less than 1251 g (CRYO-ROP study) and in 361 infants with birth weight less than 1251 g and gestational age less than 31 weeks (LIGHT-ROP study).
Results In 99% of infants, retinal conditions indicating a risk of poor outcome were not observed before 31 weeks' postmenstrual age or 4 weeks' chronologic age. Signs indicating that the risk of visual loss from ROP was minimal or had passed were the infant's attainment of 45 weeks' postmenstrual age without the development of prethreshold ROP or worse, progression of retinal vascularization into zone III without previous zone II ROP, and full vascularization.
Conclusions The initial eye examination should be conducted by 31 weeks' postmenstrual age or 4 weeks' chronologic age, whichever is later. Acute phase ROP screening can be discontinued when any of the 3 signs is present, indicating that the risk of visual loss from ROP is minimal or passed.
From the Department of Ophthalmology, University at Buffalo, Buffalo, NY (Dr Reynolds); the Departments of Ophthalmology and Psychology, University of Arizona, Tucson (Dr Dobson); the Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia and Scheie Eye Institute, University of Pennsylvania (Drs Quinn and Schaffer); Department of Ophthalmology, Imperial College School of Medicine, London, England (Dr Fielder); the Oregon Health and Science University, Casey Eye Institute, Portland (Dr Palmer); Department of Ophthalmology, Medical University of South Carolina, Charleston (Dr Saunders); the School of Public Health, The University of Texas Health Science Center, Houston (Dr Hardy and Ms Tung); the Department of Pediatrics and Ophthalmology, University of Rochester, Rochester, NY (Dr Phelps); the Department of Ophthalmology, Children's Hospital of Michigan, and Kresge Eye Institute, Wayne State University, Detroit (Dr Baker); and the Beaumont Eye Institute, William Beaumont Hospital, Royal Oak, Mich (Dr Trese).
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