An AND versus OR study of retinopathy of prematurity screening criteria.

BACKGROUND

The current United States screening criteria for retinopathy of prematurity (ROP) is highly sensitive (gestational age [GA] of ≤30 weeks or birthweight [BW] of ≤1500 g) and often result in unnecessary examinations. Indirect ophthalmoscopic ROP examinations can be stressful for infants and require fellowship-trained ophthalmologists. The purpose of this study was to evaluate the safety of excluding low-risk premature infants: those who only meet one criterion of either GA or BW.

METHODS

The medical records of premature infants who underwent ROP screening at a tertiary academic center between 2012 and 2022 were reviewed retrospectively. Demographics, BW, GA, ROP classification, rates of treatment, and need for subsequent inpatient follow-up were compared among patients that met only one criterion (OR group) versus both criteria (AND group).

RESULTS

A total of 926 charts were reviewed; 759 patients met the inclusion criteria. Of these, 181 (23.8%) OR neonates were compared to 578 (76.2%) AND neonates. No babies in the OR group developed treatment-requiring type 1 ROP, whereas 52 AND neonates (9.0%) required treatment for type 1 ROP (P < 0.001). Follow-up was necessary for 90 OR group neonates (49.7%) and 462 AND neonates (79.9%) (P < 0.001).

CONCLUSIONS

No patients in the OR group developed treatment-requiring disease, suggesting that sensitivity is maintained with the exclusion of single criterion infants. This data, consistent with other published work, suggests use of the current guidelines in developed countries be reexamined to increase specificity and decrease the number of unnecessary ROP examinations.