P2.G139: Assessment of ROP Screening Criteria: the ‘AND’ versus ‘OR’ study

Background: The current US screening criteria for Retinopathy of Prematurity (ROP) include babies with gestational ages (GA) ≤ 30 weeks or birth weights (BW) ≤ 1500 grams. Although these guidelines are 100% sensitive for predicting Type 1 ROP (retinopathy requiring treatment of either panretinal laser photocoagulation or intravitreal bevacizumab injection), they potentially result in many unnecessary examinations when neonates do not meet both criteria. Indirect ophthalmoscopic exams are stressful for infants, require pediatric-trained ophthalmologists, and can only be performed in hospitals or clinics where a skilled physician is available.

Objective: To evaluate the safety of excluding low-risk infants from the ROP screening criteria by comparing the ROP screening outcomes of infants who meet both criteria of GA and BW (“AND” group) to infants who only meet one criterion of GA or BW (“OR” group).

Methods: A single-center retrospective chart review was performed at a tertiary academic medical center on infants who received ophthalmology consults while in the NICU between 2012 and 2022. Patients were divided into the more stringent “AND” group and compared to the broader “OR” group. Rates of Type 1 ROP and the need for subsequent inpatient follow-up after the initial evaluation were assessed among the “OR” versus the “AND” groups.

Results: Out of 576 infant ophthalmology consults reviewed, 428 met at least one of the criteria for ROP screening. Of those who qualified for screening, 103 “OR” neonates (23.8%) were compared to 325 “AND” neonates. Among the “OR” group, there was no development of Type 1 ROP, while 8.9% of the “AND” group progressed to Type 1 ROP and received treatment (p=0.002). Inpatient follow-up was necessary for 56.9% of the “OR” neonates and 81.8% of the “AND” neonates (p < 0.001). The “AND” group was overall lower in weight and more preterm (p < 0.001). A total of 1563 ROP examinations were completed in this cohort, 197 of which were performed in the “OR” group (12.6%).

Conclusion: In this cohort, no patient meeting only one criterion for ROP screening (“OR” patients) progressed to Type 1 ROP, suggesting that excluding these patients from the ROP screening guidelines may not decrease sensitivity or affect patient safety. These findings, combined with other research may be used to reassess the US screening criteria for ROP. An amendment to the current guidelines to exclude low-risk infants will relieve some of the inpatient burden from excessive ROP screenings, decrease the demand for pediatric ophthalmologists, and eliminate an additional stressor on infirmed infants.