Visual disability and blindness from severe retinopathy of prematurity (ROP) may be prevented with timely treatment during the evolution of stage 3 ROP.1 Accordingly, infants at risk must be examined to discover and to follow the development of ROP.

The following guidelines are based on our current understanding of ROP as determined by our experience and that of other workers familiar with the disease.2–4 We do not include specific recommendations as to the timing and methods of treatment of ROP because of the continuous evolution of our knowledge base regarding these matters. Subsequent developments may necessitate revision of these recommendations at any time.

The Canadian Ophthalmological Society, the Canadian Association of Pediatric Ophthalmologists and the Canadian Paediatric Society recommend the following guidelines for screening premature infants for ROP.

Risk group

• Infants of 30 weeks’ gestational age or less
• Infants with a birth weight of 1500 g or less

Examiners

The examiner should be a skilled observer in the recognition of ROP, usually an ophthalmologist.

Schedule of assessments

• The first examination should be performed 4 to 6 weeks after birth.
• A follow-up examination should be carried out approximately 2 weeks after every examination that reveals no ROP.5.
• In infants in whom ROP is discovered, the frequency of examination will increase depending on the severity of disease, at the discretion of the consulting ophthalmologist.
• Infants with plus disease, ROP in zone I or evidence of stage 3 ROP should be examined at least weekly.
• Examinations should continue until the retina is adequately vascularized in zone III or the ROP has resolved.

Responsibility

The examining ophthalmologist is responsible for documenting the state of the infant’s eyes in terms of the International Classification of Retinopathy of Prematurity6 at each examination, with recommendation as to when the next examination should take place.

The attending pediatrician or neonatologist of the infant’s nursery is responsible for forwarding this information to the next attending pediatrician or neonatologist on transfer or discharge of the infant to facilitate appropriate continuing ophthalmologic care.

Long-term follow-up

Any infant who has had ROP should have a complete eye examination by an ophthalmologist 6 to 12 months after the expected date of birth.

References

1. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results. Arch Ophthalmol 1988; 106:471–9.
2. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: three-month outcome. Arch Ophthalmol 1990; 108:195–204.
3. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: one-year outcome — structure and function. Arch Ophthalmol 1990;108:1408–16.
4. Palmer EA, Flynn JT, Hardy RJ, Phelps DL, Phillips CL, Schaffer DB, et al. Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology 1991;98: 1628–40.
5. Hardy RJ, Palmer EA, Schaffer DB, Phelps DL, Davis BR, Cooper CJ. Outcome-based management of retinopathy
   of prematurity. Multicenter Trial of Cryotherapy for Retinopathy of Prematurity Cooperative Group. J Am Acad Pediatr Ophthalmol Strabismus 1997;1(1):46–54.
6. An international classification of retinopathy of prematurity. Prepared by an international committee. Br J Ophthalmol 1984;68:690–7.