title: Practice Patterns in Retinopathy of Prematurity Treatment for Disease Milder Than Recommended by Guidelines.
abstract: OBJECTIVE
  To characterize the frequency of and clinical indications for which experts treat retinopathy of prematurity (ROP) milder than type 1 disease, the recommended threshold for treatment from established consensus guidelines.
  
  
  METHODS
  Descriptive analysis.
  
  
  METHODS
  setting: Multicenter.
  
  
  METHODS
  A database of 1444 eyes generated prospectively from all babies screened for ROP at 1 of 6 major ROP centers whose parents provided informed consent.
  
  
  METHODS
  Retrospective review of the database and charts to identify all patients treated for ROP milder than type 1.
  
  
  METHODS
  Indication(s) for treatment.
  
  
  RESULTS
  A total of 137 eyes of 70 infants were treated for ROP. Of these 137 eyes, 13 (9.5%) were treated despite a clinical diagnosis milder than type 1 ROP. Indications for treatment included active ROP with the fellow eye being treated for type 1 ROP (2 eyes, 15.4%); concerning structural changes (9 eyes, 69.2%), including tangential traction with temporal vessel straightening concerning for macular dragging (8 eyes, 61.5%) and thick stage 3 membranes with anteroposterior traction concerning for progression to stage 4 ROP (3 eyes, 23.1%); persistent ROP at an advanced postmenstrual age (4 eyes, 30.8%); and/or vitreous hemorrhage (3 eyes, 23.1%).
  
  
  CONCLUSIONS
  Experts in this study occasionally recommended treatment in eyes with disease less than type 1 ROP. This study has important clinical implications and highlights the role of individual clinical judgment in situations not covered by evidence-based treatment guidelines.
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College/New York - Presbyterian Hospital, New York, New York.
authors.forename: Mrinali Patel
authors.initials: MP
authors.lastname: Gupta
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College/New York - Presbyterian Hospital, New York, New York.
authors.forename: R V Paul
authors.initials: RVP
authors.lastname: Chan
authors.affiliation: Eye Institute, St Luke's Medical Center, Quezon City, Philippines.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Anzures
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
authors.forename: Susan
authors.initials: S
authors.lastname: Ostmo
authors.affiliation: Department of Ophthalmology, Weill Cornell Medical College/New York - Presbyterian Hospital, New York, New York.
authors.forename: Karyn
authors.initials: K
authors.lastname: Jonas
authors.affiliation: Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon; Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon. Electronic address: chiangm@ohsu.edu.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Chiang
mesh_terms: D001724:Birth Weight; D016208:Databases, Factual; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D017075:Laser Coagulation; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012178:Retinopathy of Prematurity / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D014821:Vitrectomy; D014823:Vitreous Hemorrhage / Q000601:surgery