The American Academy of Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics Share Announcement

SAN FRANCISCO—Three medical societies have set out a series of recommendations on which to base the effective detection and treatment of retinopathy of prematurity, a disorder that can affect the developing retina of premature infants and lead to blindness. The American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics issued the joint statement, which is an update of a previous statement issued in 2001.

The statement discusses improvements in the possible treatment of ROP and the importance of carefully timed retinal exams by an ophthalmologist for at-risk premature infants.

“Recent developments in peripheral retinal ablative therapy using laser photocoagulation, and demonstration of their efficacy, have resulted in the possibility of markedly decreasing the incidence of poor visual outcome,” said Walter M. Fierson, MD, chairperson of the American Academy of Pediatrics Retinopathy of Prematurity Subcommittee. “But the sequential nature of ROP creates a requirement that at-risk preterm infants be examined at proper times to detect the changes of ROP before they become permanently destructive.”

A 10-year follow-up report from the Multicenter Trial Cryotherapy for Retinopathy of Prematurity demonstrated the effectiveness of peripheral retinal cryotherapy in reducing unfavorable outcomes, from 48 percent to 27 percent in structural outcomes and from 62 percent to 44 percent in unfavorable visual outcomes.

Another significant update to this joint statement is the addition of a table designed to help practitioners better determine the timing of the first eye examination, based on gestational age at time of birth rather than chronological age. 

“Determining the infant’s gestational age gives us a much more accurate assessment of when the child should be examined, as the youngest infants at birth take the longest time to develop serious ROP,” said Michael X. Repka, MD, president of the American Association for Pediatric Ophthalmology and Strabismus and a member of the statement review subcommittee. “The table provides a schedule for detecting ROP before it becomes severe enough to miss the optimum time for ablative therapy, while at the same time, minimizing the number of potentially traumatic examinations.”

According to the joint statement, the overall goal of a screening program should be to identify the premature infants who require treatment for ROP from among the larger population of at-risk infants, while limiting exams as much as possible. It is suggested that efforts should be made to reduce the discomfort and systemic effect of examinations by pre-treating the infant’s eyes with a topical anesthetic agent, such as proparacaine, and by using pacifiers, oral sucrose and other soothing methods.