Retinopathy of prematurity

ROP in low and middle income countries

Ophthalmologist screening a preterm infant for ROP, with the support of nurses, in a neonatal intensive care unit in Brazil.

1. Research findings
2. Initiatives for control

Retinopathy of prematurity (ROP) is an increasingly important cause of potentially avoidable blindness and vision impairment in children, particularly in Asia. Control entails improving the quality of neonatal care, and early detection and treatment of sight threatening ROP. Recent publications include the following.

Preterm infant in an incubator receiving unmonitored oxygen via the blue tube

Publications

  • Clare Gilbert, Richard Wormald, Alistair Fielder, Ashok Deorari, Luz Consuelo Zepeda-Romero, Graham Quinn, Anand Vinekar, Andrea Zin, and Brian Darlow. Potential for a paradigm change in the detection of retinopathy of prematurity requiring treatment. Arch Dis Child Fetal Neonatal Ed 2015;0:F1–F4. doi:10.1136/archdischild-2015-308704. Article.
  • Consuelo Zepeda-Romero, Alonso Meza-Anguiano, Juan Carlos Barrera-de León, Eusebio Angulo-Castellanos, Marco Antonio Ramirez-Ortiz, Citlali Lara-Molina, José Alfonso Gutiérrez-Padilla, Hector Raul Perez-Gomez and Clare E. Gilbert. Case series of infants presenting with end stage retinopathy of prematurity to two tertiary eye care facilities in Mexico: underlying reasons for late presentation. Matern Child Health J. 2014 DOI 10.1007/s10995-014-1648-z. Article.
  • Negretti GS, Ayoub T., Ahmed S., Deb R., Majumder U., Jewel J,, Muhit M., Gilbert CE and Richard JC Bowman. Cataract surgery outcomes in Bangladeshi children. Ophthalmology. 2015 Feb 19. pii: S0161-6420(15)00083-4. Abstract.
  • Yi Chen, Jing Feng, Clare Gilbert, Hong Yin, Jianhong Liang and Xiaoxin Li. Time at treatment of severe retinopathy of prematurity in China: recommendations for guidelines in more mature infants. PLOS one. 2015 Feb 9;10(2):e0116669. doi: 10.1371/journal.pone.0116669. eCollection 2015. Abstract.
  • Zepeda-Romero LC, Meza-Anguiano A, Barrera-de León JC, Angulo-Castellanos E, Ramirez-Ortiz MA, Gutiérrez-Padilla JA, Gilbert Case series of infants presenting with end stage retinopathy of prematurity to two tertiary eye care facilities in Mexico: underlying reasons for late presentation. Matern Child Health J. 2015 Jun;19(6):1417-25. doi: 10.1007/s10995-014-1648. Abstract.
  • Consuelo Zepeda-Romero and Clare Gilbert. Limitations in ROP programs in 32 neonatal intensive care units in five states in Mexico. BioMed Res Int. 2015 Article ID 712624. Article.
  • Fielder A., Blencowe H., O’Connor A. and Gilbert C. Impact of retinopathy of prematurity on ocular structures and visual functions. Arch Dis Child Fetal Neonatal Ed 2014;0:F1–F6. doi:10.1136/ Arch Dis Child- 2014-306207. Abstract.
  • Andrea A. Zin, Cynthia Magluta, Marcia Pinto, Aline Entringer, Maria Auxiliadora  de Sousa Mendes Gomes, Maria Elizabeth Lopes Moreira, Clare E. Gilbert. Retinopathy of prematurity screening and treatment cost in Brazil. Rev Panam Salud Publica. 2014 Jul;36(1):37-43. Abstract.
  • Anand Vinekar , Clare Gilbert, Mangat Dogra, Mathew Kurian, Gangadharan Shainesh , Bhujang Shetty and Noel Bauer. The KIDROP model of combining strategies for providing Retinopathy of Prematurity screening in underserved areas in India using wide-field imaging, telemedicine, non-physician graders and smart phone reporting. Ind J Ophthalmol. 2014 41-49. Abstract.
  • Clare Gilbert, Brian Darlow, Andrea Zin, Selvaraj Sivasubramaniam, Shaheen Shah, Nicole Gianini, Gina Beecroft, RN and Maria Elisabeth Lopes Moreira.  Educating neonatal nurses in Brazil: before and after study with interrupted time series analysis. 2014 106(3):201-208. Abstract.
  • Fielder A, Blencowe H, O’Connor A, Gilbert Impact of retinopathy of prematurity on ocular structures and visual functions. Arch Dis Child Fetal Neonatal Ed. 2015 Mar;100(2):F179-84. doi: 10.1136/archdischild-2014-306207. Epub 2014 Oct 21. Review. Article.
  • Blencowe H, Lawn JE, Vazquez T, Fielder A, Gilbert Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res. 2013 Dec;74 Suppl 1:35-49. doi: 10.1038/pr.2013.205. Review. Article.
  • Darlow B., Gilbert C and Chiroga, A. Chapter in Clinics in Perinatology. Setting up and improving ROP programs – interaction of Neonatology, Nursing and Ophthalmology.  Clinics in Perinatology 2013 40: 215-227. Abstract.
  • Hannah Blencowe, Joy E Lawn, Thomas Vazquez, Alistair Fielder and Clare Gilbert  Beyond newborn survival: Paper 3. Preterm associated visual impairment and estimates of retinopathy of prematurity at regional and global level for 2010.  Pediatric Research. 2013 54: 36-49. Abstract.
  • Urrets-Zavalia JA., Crim N., Knoll EG., Esposito FA., Collino E., Urrets-Zavalia ME., Saenz-de-Tejada G.,  Torrealday JI., Serra HM. and Gilbert C. Impact of changing oxygenation policies on retinopathy of prematurity in a neonatal unit in Argentina. Brit J Ophthalmol. 2012. 96: 1456-61. Abstract.
  • Anand Vinekar, Kavitha Avadhani, Mangat Dogra, Praveen Sharma, Clare Gilbert, Sherine Braganza, and Bhujang Shetty. A Novel, Low-Cost Method of Enrolling Infants at Risk for Retinopathy of prematurity in Centers with No Screening Program: The REDROP Study. Ophthalmic Epidemiol  2012 19(5), 317–321. Abstract.
  • Brian A. Darlow, Andrea A. Zin, Gina Beecroft, Maria E.L. Moreira, and Clare E. Gilbert. Capacity building of nurses providing neonatal care in Rio de Janeiro, Brazil: methods for the POINTS of Care project to enhance nursing education and reduce adverse neonatal outcomes.  BMC Nursing 2012 11:3. Abstract.
  • Brian A. Darlow, Anna L. Ells, Clare E. Gilbert, Glen A. Gole and Graham E. Quinn. Are we there yet? Bevacizumab therapy for acute retinopathy of prematurity. Arch Dis Child Fetal Neonatal Ed 2013 98 F170-174. Abstract.
  • Vinekar A, Avadhani K, Braganza S, Shetty B, Dogra M, Gilbert C. Outcomes of a Protocol-Based Management for Zone 1 Retinopathy of prematurity: the Indian twin cities ROP screening program report number 2. Am J Ophthalmol. 2011 152: 712. Abstract.
  • Zepeda-Romero LC, Barrera-de-Leon JC, Camacho-Choza C, Gutierrez-Padilla JA and Gilbert C. Retinopathy of prematurity as a major cause of severe visual impairment and blindness in children in schools for the blind in Guadalajara city, Mexico.Brit J Ophthalmol. 2011 95: 1502-1505. Abstract.
  • Zepeda-Romero LC, Barrera-de-Leon JC, Camacho-Choza C, Gonzalez Bernal C, Camarena-Garcia E, Diaz-Alatorre C, Gutierrez-Padilla JA, Gilbert Retinopathy of prematurity as a major cause of severe visual impairment and blindness in children in schools for the blind in Guadalajara city, Mexico. Br J Ophthalmol. 2011 Nov;95(11):1502-5. doi: 10.1136/bjophthalmol-2011-300015. Epub 2011 Jun 7. Article.
  • Quinn Graham E, Gilbert Clare, Darlow Brian A and Zin Andrea. Retinopathy of prematurity: an epidemic in the making. Chinese Medical Journal. (Engl). 2010 Oct;123(20):2929-37. Abstract.
  • Andrea Zin, Bebeth Lopes, Catey Bunce, Brian Darlow and Clare Gilbert. Retinopathy of prematurity in 7 neonatal units in Rio de Janeiro, Brazil: screening criteria and workload implications. Pediatrics. 2010 126: e410-417. Abstract.
  • Anand Vinekar,  Clare Gilbert, Shireen Braganza,  Kaushik Hegde,, P Maiya, Pradeep GCM, and Shruthi Patil. Do platelets have a role in the pathogenesis of aggressive posterior retinopathy of prematurity? Retina 2010 30(4) S20-S23. Abstract.
  • Parag K. Shah, V. Narendran, N. Kalpana and Clare Gilbert. Severe retinopathy of prematurity in big babies: history repeating itself? Indian J Pediatrics. 2009 76 801-804. Abstract.

 

Supporting initiatives to integrate control of visual loss retinopathy of prematurity control into existing health systems in India

India has the highest number of preterm births of any country, and the Ministry of Health is scaling up District level Special Newborn Care Units across the country to address this need. The survival of preterm infants is increasing as a consequence but they are now at greater risk of blindness from ROP.  It is estimated that up to 15% of infants receiving neonatal care and who weigh less than 2000g at birth develop the “sight threatening” form of ROP which requires treatment. Once vision has been lost from ROP it usually cannot be restored, but much can be done to control blindness from ROP by improving the quality of neonatal care, and by the early detection and treatment should sight threatening ROP develop. However, at the moment screening/detecting and treating ROP is not an integral part of services for care of the premature newborn in the government sector.

The Queen Elizabeth Diamond Jubilee Trust, who are supporting initiatives for the control of avoidable blindness across the Commonwealth, are supporting a large scale programme in India where the goal is to integrated initiatives for the control of visual loss from ROP into existing health systems. Staff at ICEH are playing a major role, providing technical and managerial input.

A National Summit on Retinopathy of Prematurity was held in 2013, and a National ROP Task Force has been established. Four Technical Working Groups have been established, and model programmes for the detection and treatment of sight threatening ROP will be implemented shortly in States which have been selected for Trust support.

Visit the Queen Elizabeth Diamond Jubilee Trust website

Download the Retinopathy of Prematurity Summit Hyderabad, April 12-14th 2014 Report (PDF)

Download the Delhi  Retinopathy of Prematurity Declaration (PDF)

Image credits: Top, Ophthalmologist screening a preterm infant for ROP, with the support of nurses, in a neonatal intensive care unit in Brazil. Middle, Preterm infant in an incubator receiving unmonitored oxygen via the blue tube. Clare Gilbert.

Comments are closed.