SAN FRANCISCO—A study commissioned by the American Academy of Ophthalmology finds that only half of pediatric and retina specialists currently treat retinopathy of prematurity (ROP), and that one-fifth of these physicians plan to stop taking these infants as patients.

ROP is a potentially blinding disease affecting premature infants. After these infants are born, normal retinal development can become compromised, leading to abnormal blood vessel growth that can bleed, generate scar tissue and cause retinal detachment, the main cause of visual impairment and blindness in ROP.

With malpractice settlements in the multi-million dollar range, this study shows an increasing number of physicians are shying away from the field over the past decade—a trend consistent with that of other high-risk medical specialties. The Academy and the American Medical Association will share the survey results with Congress to illustrate the urgency of medical malpractice reform.

Half of the doctors who no longer take ROP cases gave up the practice within the last ten years. Among them, 67 percent said medical liability—including the high cost of liability insurance, the refusal of hospitals to cover screening and treatment and the fact that parents can sue until the child reaches age 19—was the most influential factor in their decision. Other top reasons cited were poor reimbursement (37 percent) and the complexity of scheduling care for children (50 percent). Among those who expect to stop treating these patients, the two top reasons cited were the issue being outside the physician’s area of interest (10 percent) and high liability (7 percent).

“Already hospitals and neonatologists are having a hard time getting ophthalmologists to see these premature infants,” said Michael Repka, M.D., professor of ophthalmology, Johns Hopkins University. “This is a real crisis because of the growing number of premature infants, and the imperative to identify and rapidly treat infants who are likely to progress to sight-threatening disease.”

H. Dunbar Hoskins Jr., M.D., Academy executive vice president, further added, “This is yet another reason for legislators to implement meaningful tort reform.”

ROP threatens 80,000 premature babies annually in the United States and causes blindness in up to 600. Effective screening and timely treatment reduce the risk of vision loss from ROP. But the risk of vision loss from ROP is growing, because ROP specialists are scarce while the number of premature babies is increasing. The rate of premature births rose from 9.4 percent to 12.3 percent between 1981 and 2003, according to the March of Dimes.

Academy leaders were not surprised by the survey results. Having predicted the looming physician shortage, they commissioned the survey of pediatric or retina specialists to determine the extent of the problem.[1] Survey results can be found on the Academy’s Web site, www.aao.org, and will also be reported in the July/August edition of the Academy’s member magazine, EyeNet.