Posterior Pole Vascular Changes Before Treatment of Retinopathy of Prematurity.

IMPORTANCE

: Some proponents of telemedicine screening for retinopathy of prematurity (ROP) believe a screening system based on posterior pole vessel characteristics is sufficient for identifying infants needing treatment.

OBJECTIVE

: To evaluate the vascular characteristics present when it was determined treatment was needed, and the number of days between examinations from when the vessels of both eyes were last noted to be normal until a decision was made to treat.

DESIGN

: Retrospective study; June 2013-May 2017

SETTING

: Neonatal intensive care unit; academic medical center

PARTICIPANTS

: All infants treated for ROP who were longitudinally examined at our institution

MAIN OUTCOMES AND MEASURES:: Vascular characteristics present on clinical examination when it was determined an infant needed treatment and the number of days between examinations from when the vessels of both eyes were last noted to be normal until a decision was made to treat.

RESULTS

: 55 infants met eligibility criteria, with mean birthweight 733g (range: 420–1060), gestational age 25.1 weeks (range: 22.9–27.7), and post menstrual age at the time a decision was made to treat 36.7 weeks (range: 31.4–43.0). When it was determined an infant needed treatment, 51 (92.7%) had plus disease, 3 (5.5%) pre-plus, and one (1.8%) neither. The number of days between examinations from when an infant was noted to have normal vessels bilaterally until a decision was made to treat was 0 to 49 days. The interval was at least 14 days for 42 infants (76%) and at least 7 days for all but one infant (98%). The exception was one infant with the rare scenario of neither pre-plus nor plus with zone I, stage 3 ROP (type 1 ROP) at the time the examiner decided to treat.

CONCLUSIONS AND RELEVANCE:: At the time it was determined an infant needed treatment for ROP, all but one infant had pre-plus or plus disease. These results suggest that narrow-field imaging for ROP screening should include all of zone I, to identify the rare treatment-requiring ROP with normal posterior pole vessels. If confirmed, with sufficient image quality, weekly photographic screening of zone I likely should capture changes indicative of impending treatment-requiring ROP.