Timing of Initial Screening Examinations for Retinopathy of Prematurity

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Abstract
THE IMPORTANCE of screening eye examinations for retinopathy of prematurity (ROP) has dramatically increased as clinical studies have shown improved visual outcomes in infants with severe, acute ROP after treatment with either transscleral cryotherapy1-4 or transpupillary laser therapy.5-9 In 1995, the Royal College of Ophthalmologists British Association of Perinatal Medicine recommended that the first eye examination take place between 6 and 7 weeks of chronological age in infants deemed at risk for ROP.10 More recently, the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology released a joint statement recommending that initial screening examinations be performed between 4 and 6 weeks of chronological age or 31 and 33 weeks of postconceptional age.11 Although the concept of considering both chronological age and postconceptional age represents an advance over previous approaches, these guidelines lack specificity. For example, a conservative examiner might screen all infants at 4 weeks of chronological age, regardless of postconceptional age, while a more liberal examiner could choose to screen infants at 33 weeks of postconceptional age regardless of chronological age. While both regimens adhere to current recommendations, we suspected that the more stringent protocol would result in many unnecessary examinations while the more liberal protocol might fail to diagnose the onset of threshold ROP in a substantial number of infants.