Validation of a Published Model to Reduce Burden of Retinopathy of Prematurity Screening

Purpose: The E-ROP study evaluated 1257 patients screened for retinopathy of prematurity (ROP), and found that no infant born at or after 27 weeks' gestational age and having a birthweight over 750 g developed treatable disease if they had no ROP at 37 weeks' gestational age. The study investigators suggested that there is little value in continued screening of infants meeting these criteria who have no ROP at 37 weeks. We attempted to replicate these published data in a larger multi-center cohort to validate or refute this hypothesis.

Design: Retrospective cohort study.

Methods: We conducted a chart review of every infant treated for ROP from February 2004 through April 2022 at 6 medical centers located in the mid-southern region of the United States. We evaluated gestational age, birthweight, and presence or absence of ROP at 37 weeks' gestational age to determine whether any treated infants would have been "missed" using these screening criteria.

Results: Of 6729 infants screened, 298 (4.43%) received treatment. Ten infants who required treatment developed first evidence of ROP after 37 weeks' gestational age. However, only 1 infant was >750 g birthweight and >27 weeks' gestational age. This patient developed zone 2, stage 3 with pre-plus disease and was treated because of limited access to care at a remote hospital; however, ROP was detected at the first examination after 37 weeks, so this infant would have been identified for continued follow-up.

Conclusion: Our results, in a cohort 5 times that of the original study, replicated that infants >750 g birthweight and >27 weeks' gestational age did not develop treatable ROP if they had no ROP at 37 weeks, supporting the termination of examination at that time in patients meeting these criteria.