Introduction
Retinopathy of prematurity (ROP) is an abnormal development of retinal blood vessels in premature infants as a result of immature and incomplete vascularization of the retina. Visual impairments such as retinal detachment and blindness can occur in infants at risk if symptoms progress to the advanced stages. Generally infants identified at greatest risk are those who are of low birth weight and/or gestational age. These infants require screening examinations at regular intervals in order to determine the need for treatment. Early treatment has been shown to improve outcomes.
The lack of timely and equitable access to high quality eye examinations and treatment for ROP has been identified as an issue within the province. The availability of ROP screening has long been recognized as a barrier to retro-transfer of premature infants who no longer require level III NICU care. At risk infants born at Level II sites where ROP screening services are limited or non-existent must be transferred or transported to centres that can provide ophthalmic examinations. Transports create potential risk to the infant and have significant cost implications for the sending hospital. Transfers create an emotional and economic burden for the family.
Technology is available to allow for remote capture of images which can be transmitted electronically from a “sending” to a “reading” centre where a paediatric ophthalmologist, skilled in the identification and staging of ROP, reviews the images. This option provides closer¬to-home care for neonates at risk for ROP while ensuring access to essential screening examinations.
In June, 2008 the Provincial Council for Maternal and Child Health convened a panel of experts in the field of ROP, along with administrators and clinicians in neonatal and paediatric care, to recommend strategies to achieve a coordinated system for remote ROP screening services within the province. The group worked on several objectives relating to remote screening and improving access to care. They were also tasked with recommending clinical guidelines for ROP eye examinations to promote consistency and standardization of practice across all hospitals.
Clinical Guidelines for Screening Examinations for Retinopathy of Prematurity
The following Guidelines are intended to be a resource to assist clinicians in the identification and screening of infants at risk for ROP.
Recommendation #1
The ROP Work Group recommends that the 2010 Canadian Paediatric Society Retinopathy of Prematurity (ROP) Screening1 guidelines serve as Ontario’s provincial guidelines.
1. Canadian Paediatric Society, Fetus and Newborn Committee [Principal author: A.L. Jefferies]. Retinopathy of prematurity: Recommendations for screening. Paediatrics & Child Health 2010; 15(10): 667-670