Objective: To determine the applicability of a modified criteria for initiating retinal examinations to screen for retinopathy of prematurity (ROP). Methods: All ROP charts of babies who had initial retinal examination to screen for ROP from January 1, 2005 to December 31, 2008 at the neonatal-intensivecare nursery and eye center of a tertiary hospital were reviewed. Date of birth, sex, age of gestation (AOG), birth weight (BW), postnatal age (PNA), postconceptional age (PCA), and ROP classification were recorded. Descriptive statistics and Student’s t-test were used to analyze the data. Results: A total of 690 eyes of 345 babies, 174 males and 171 females, were included in the study. At the initial retinal exam, the mean AOG was 31.39 ± 2.46 weeks; BW, 1,268.77± 317.12 grams; PNA, 4.56 ± 2.95 weeks; and PCA, 35.94 ± 3.26 weeks. Immature retinas in both eyes were seen in 175 (50.72%) babies, while 113 (32.75%) had ROP of any stage in both eyes and 51 (14.78%) had immature retina in one eye and ROP of any stage in the other eye. Among the 113 babies with ROP, 33 (29.2%) were assessed to have pre-threshold ROP. Conclusion This study supported the applicability of the modified criteria which are in agreement with the Joint Statements of the American Academy of Pediatrics, American Academy of Ophthalmology and American Association of Pediatric Ophthalmology and Strabismus, and the United Kingdom Royal College of Pediatrics and Child Health for initiating retinal exams to screen for ROP.
Retinopathy of Prematurity

Objective: To validate WINROP, a web-based screening tool for retinopathy of prematurity (ROP), in the detection of any-stage ROP or treatment-requiring ROP among Filipino preterm infants screened for ROP from January 2013 to April 2017. Methods: Charts of preterm infants who were screened for ROP at a tertiary hospital from January 2013 to April 2017 were reviewed. Birth date, gestational age, birth weight, and weekly postnatal weight measurements were collected and entered into WINROP. The number of infants that were tagged by WINROP with alarm signals for any-stage ROP or treatment-requiring ROP were noted and compared with actual ROP screening findings. The sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the WINROP application in predicting any-stage ROP and treatment-requiring ROP were computed. Results: Charts of 138 preterm infants were included in the study. Sixty-four (64) had a chart diagnosis of anystage ROP and 13 had treatment-requiring ROP. WINROP tagged 77 and 10 preterm infants with any-stage ROP and treatment-requiring ROP, respectively. The sensitivity and specificity rates of WINROP for detecting any-stage ROP were 63.5% (95% CI: 51.5% - 74.2%) and 78.1% (95% CI: 65.7% - 87.1%), respectively. While the sensitivity and specificity rates at identifying treatment-requiring ROP were 76.9% (95% CI: 45.9% - 93.8%) and 46.4% (95% CI: 37.5% - 55.5%), respectively. Conclusion WINROP is fairly sensitive and specific in predicting any-stage ROP but has fair sensitivity and poor specificity in predicting treatment-requiring ROP. WINROP may aid in ROP prediction, but regular screening of preterm infants at risk for ROP based on current criteria remains to be the standard of care.
Retinopathy of Prematurity

Retinopathy of Prematurity

Objective: The study protocolaims to provide an overview of the current practice of screening and treatment of ROP in the selected, to estimate the proportion of childhood blindness due to ROP and assess the number of premature babies at risk for ROP. Methods: The study protocol is a descriptive, cross sectional study design using survey questionnaire to be sent out to pediatric ophthalmologists, vitreo-retina specialists and division heads of the neonatal intensive care units of different hospitals in a selected area. Student records and medical abstracts from local schools for the blind will be obtained and will be reviewed. All qualitative data will be reported by frequency distribution and percentages. Extrapolation on the proportion of ROP in the area will be done. Conclusion Results from the study can show an overview of the current situation of ROP in a selected area and provide the framework for recommendations for programs aimed providing criteria for timely screening and treatment of ROP to prevent complications such as childhood visual impairment and blindness in the country.
Retinopathy of Prematurity ;

Retinopathy of prematurity (ROP) is a vaso-proliferative disorder affecting the retina of premature babies. It is a potentially blinding disease and is now one of the most common causes of life-long vision impairment and blindness in children in middle- income countries like the Philippines.
Retinopathy of Prematurity

No abstract available.
Retinopathy of Prematurity* ; Risk Factors*

Despite the proven benefit of cryotherapy in the management of threshold retinopathy of prematurity (ROP), it was shown leading to ocular adverse effects. A male infant was born at 28 week of gestation with a birth weight of 1200 g. Serial examinations revealed worsening ROP in both eyes until he reached a high risk pre-threshold ROP in his right eye and threshold ROP in his left eye. Cryotherapy was performed for the threshold ROP in the left eye while the right eye was subjected to further observation. Subsequently, ROP in both eyes regressed without cicatrisation. The patient was followedup over 8 years and refractions showed that the treated eye developed steadily increasing myopia while the untreated eye remained emmetropic. This case demonstrated the detrimental effect of cryotherapy to the treated eye leading to the progressive myopia as the child grew.
Retinopathy of Prematurity ; Cryotherapy

In this day and age of research and constantly improving methods of research conduct and protocols, policies are determined, to a large part, by the results of these researches, most of which are numbers. So in addressing the growing need to prevent blindness from Retinopathy of Prematurity (ROP), experts worldwide, in at least 2 major landmark studies and 4 World ROP Congresses, agreed on the definitions of high-risk criteria, with emphasis on timely referral. These were all meant to guide the pediatricians in referring premature babies for ROP screening. These efforts were meant to drive home a very important point: the occurrence of visually-debilitating stages of ROP are preventable. The incidence of blindness from ROP is quite small, but nonetheless, catastrophic to the patient. To speak of those numbers is not my purpose today. My purposes are to put a face and a voice to those who are “the tiny number … the small incidence” crying out from the outer edges of bar graphs, and to remind everyone that that tiny number of blind and nearly blind children are people with lives to live, and futures to look forward to, just like the rest of us. Certainly, opening that golden window of opportunity is the most important thing that one can do for the premature baby at risk of developing ROP. One is not born with ROP. No one wants to have it. No parent will want his child to have it. And if one does have it, one must be protected from the deleterious consequences of ROP. This will happen only if everyone concerned will just do what they have to do. Screening of a high-risk baby by an ophthalmologist cannot be done without a referral from the attending pediatrician. The tireless efforts of neonatologists and pediatricians in keeping the premature babies alive and managing all their life-threatening conditions are truly laudable. However, we must insist that sight is just as important. We must insist that high-risk babies be referred to an ophthalmologist for ROP screening. The importance of a wholistic approach in the management of a premature baby cannot be overemphasized. Quality of life should be a primary consideration when it comes to any situation where something has been compromised. To drive home a point, please do this: Imagine your child blind. Then think of everything that a blind child will miss in his life. Think of all the difficulties that the blind child will encounter in his entire life. Think of all the difficulties and the heartaches for the parents of the blind child. Then think of how this blind person will be when the doting parents who took care of him will one day no longer be around. A parent of an ROP blind child once said “To a parent there are no statistics. My child is always 100%.” And finally, think about these wise words from Nelson Mandela: History will judge us by the difference we make in the everyday lives of children.
Retinopathy of Prematurity ; Blindness

Objective: (1) To determine if preterm babies with ROP are missed with the existing Philippine Pediatric SocietyPhilippine Academy of Ophthalmology 2005 screening criteria of ≤32 weeks gestational age (GA) and ≤1,500 grams birth weight (BW), (2) to determine the incidence (missed-out rate) of these babies with ROP (>32 weeks GA, >1,500 grams BW), (3) to describe their profile, and (4) to determine the appropriate upper limit for GA and BW that can provide safe and efficient screening for severe ROP. Methods: This is a multicenter, retrospective cohort, observational study using data on ROP screening from the medical records of preterm babies from 4 institutions. All babies born ≤36 weeks GA, regardless of BW, who previously underwent ROP screening in 2011-2013, were included. Outcome measures were: (1) missed-out rate, (2) profile of missed babies with ROP (GA, BW, and risk factors), and (3) the proposed new criteria. Results Of the 762 babies screened, 105 (13.8%) had ROP. Of these, 13 (12%) had severe ROP, 28 (27%) was born at 33-36 weeks GA, and 32 (30%) with >1,500 grams BW. The oldest and heaviest of these missed babies with type 1 ROP was almost consistently reported at <35 weeks GA and <2,000 grams BW. Associated significant risk factors seen among missed babies were sepsis, respiratory distress syndrome (RDS), oxygen supplementation, and blood transfusion. There were 45 babies (43%) with ROP but with no risk factors. Among these were babies with GA >32 weeks and BW >1500 grams with ROP. The incidences of ROP, with and without risk factors, in the 4 institutions were not statistically significant. Seventeen (16.2%) preterm babies were missed with the existing criteria. Two of these had no risk factors but had type 1 and type 2 ROP. When <35 weeks GA and <2,000 grams BW as the new criteria were applied, the missed-out rate was reduced to 2% and was further reduced to zero with the inclusion of risk factors.
Retinopathy of Prematurity ; Mass Screening

Objective: (1) To determine the inter and intra-observer reliability in diagnosing ROP in terms of the stage, zone, and presence of plus disease among local ROP screeners involved in the ROP Working Group; and (2) to determine the inter-observer reliability between 2 groups of subspecialties – retina specialists and pediatric ophthalmologists. Methods: This is a prospective observational study that analyzed the inter- and intra-observer reliability in describing ROP in 3 key observations: stage, zone, and presence of plus disease. This study utilized a test with 32 sets of fundus images from 27 cases, five of which were repeated. Images from previously photographed infants with and without ROP were collated into a downloadable powerpoint test and tested against retina specialists and pediatric ophthalmologists of the ROP Working Group. Outcome measures included presence of variability in ROP diagnosis in terms of the stage, zone, and presence of plus disease among screeners, and reliability coefficient (intra-class coefficient or ICC) in 2 levels: (1) individual and 2-group inter-observer reliability, and (2) intra-observer reliability. Results: There were 11 respondents: 5 retina specialists and 6 pediatric ophthalmologists. Seven (46%) reported prior experience with RetCam image review. There was high inter-observer reliability (ICC 1.0) in the staging of ROP, but poor reliability in the identification of zone (ICC 0.3) and plus disease (ICC 0.5). The group of retina specialists and pediatric ophthalmologists scored high reliability for diagnosis of stage (ICC 1.0 vs 0.9) and plus disease (ICC 0.9 vs 0.9), while both showed poor reliability in the identification of zone (ICC 0.5 vs 0.4). Majority had high intra-observer reliability with regard to the stage (55%) and zone (73%) of ROP and most (73%) had acceptable intra-observer reliability in identifying plus disease. None of the respondents had poor intra-observer reliability. Conclusion The diagnosis of the stage of ROP was consistently reliable for both inter- and intra-observer parameters. However, identification of zone of ROP and plus disease were sources of significant discrepancies.
Retinopathy of Prematurity ; Mass Screening