title: Lack of Screening Underlies Most Stage-5 Retinopathy of Prematurity among Cases Presenting to a Tertiary Eye Center in India.
abstract: OBJECTIVE
  To study the barriers to effective screening, early detection and treatment of Retinopathy of Prematurity leading to advanced disease.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Tertiary eye care hospital in northern India.
  
  
  METHODS
  115 babies with bilateral stage 5 ROP identified amongst 354 preterm infants examined over a one year period.
  
  
  METHODS
  Information regarding gestational age, birthweight, duration of stay in nursery, duration of supplemental oxygen therapy and treatment details were obtained from discharge summary when available, and by interviewing carers.28 stage 5 ROP eyes underwent pars plana lensectomy and vitrectomy.
  
  
  RESULTS
  Among the 354 infants (708 eyes) examined, 115 had stage 5 ROP in both eyes. The mean post conceptional age (PCA) at first visit to an ophthalmologist was 54.6 (7.6) weeks (Median 52.9 ± 4.2). The mean overall delay in first examination for Retinopathy of Prematurity was 24.7 (3.9) weeks. Most common risk factor was oxygen therapy in 103 babies (89.6%). 109 (89.8%) babies had never been screened for ROP; four babies fell outside the NNF guidelines (i.e. they had a birth weight of 1750 gms or more and were born at 34 weeks gestational age or more). Another important finding is that only 4.3% of babies were given the correct diagnosis. While 99 babies (86.1%) were referred by ophthalmologists, only 10 babies (8.7%) were referred by pediatricians. A large number were from the capital city of Delhi (21 babies, 18.2%). 28 stage 5 ROP eyes (12.1%) underwent surgery, and at 6 months follow up, only 20 operated eyes had visible attached posterior pole. 210 (91.3%) stage 5 eyes were irreversibly blind.
  
  
  CONCLUSIONS
  ROP is an increasingly important cause of leucocoria. There were notable gaps in timely ROP screening, referral and treatment and much needs to be done to improve awareness amongst ophthalmologists about ROP. Measures are needed to improve the coverage of initiatives for the detection and timely treatment of sight threatening ROP in India as well as improving neonatal care to reduce sight threatening ROP in bigger, more mature infants.
authors.affiliation: Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Parijat Chandra, Additional Professor of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. parijatchandra@gmail.com.
authors.forename: Rajvardhan
authors.initials: R
authors.lastname: Azad
authors.forename: Parijat
authors.initials: P
authors.lastname: Chandra
authors.forename: Anil
authors.initials: A
authors.lastname: Gangwe
authors.forename: Vivek
authors.initials: V
authors.lastname: Kumar
mesh_terms: D001724:Birth Weight; D001766:Blindness / Q000517:prevention & control; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D005865:Gestational Age; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D015997:Neonatal Screening; D010100:Oxygen / Q000009:adverse effects / Q000627:therapeutic use; D012178:Retinopathy of Prematurity / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D010100:Oxygen