Rethinking STOP-ROP: is it worthwhile trying to modulate excessive VEGF levels in prethreshold ROP eyes by systemic intervention? A review of the role of oxygen, light adaptation state, and anemia in prethreshold ROP.
OBJECTIVE
To review systemic modifiable factors that might downregulate pathologic levels of vascular endothelial growth factor (VEGF) in prethreshold retinopathy of prematurity (ROP), and thereby reduce the risk of blindness in affected infants.


METHODS
Review of the author's clinical experience as compared to the STOP-ROP study, and discussion and literature review of the potential effects of oxygen supplementation, light adaptation state, and correction of severe anemia on the course of prethreshold retinopathy of prematurity (ROP).


RESULTS
Moderate oxygen supplementation, combined with light adaptation to reduce retinal oxygen consumption and correction of severe anemia, were associated, in the author's experience, with improvement in the clinical course of prethreshold ROP. Withdrawal of these measures was often associated with deterioration of ROP.


CONCLUSIONS
Systemic measures can be taken that may reduce the risk of blindness in infants with prethreshold ROP. For those infants who require laser treatment for threshold ROP, prior efforts to moderate excessive levels of VEGF may improve the chances of a successful surgical result, by slowing the momentum of the disease.
Gaynon
Michael W
MW
Palo Alto Medical Clinic, California 94301, USA. opmed@earthlink.net
D000221:Adaptation, Ocular / Q000502:physiology*; D000740:Anemia / Q000097:blood / Q000503:physiopathology*; D001766:Blindness / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption / Q000502:physiology*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011379:Prognosis; D012178:Retinopathy of Prematurity / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism*
C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D010100:Oxygen