Treatment trends for retinopathy of prematurity in the UK: active surveillance study of infants at risk.
To estimate the incidence of severe retinopathy of prematurity (ROP) requiring treatment and describe current treatment patterns in the UK.



Nationwide population-based case ascertainment study via the British Ophthalmic Surveillance Unit and a national collaborative ROP special interest group. Practitioners completed a standardised case report form (CRF).



All paediatric ophthalmologists providing screening and/or treatment for retinopathy in the UK were invited to take part.



Any baby with ROP treated or referred for treatment between 1 December 2013 and 30 November 2014, treated with laser, cryotherapy, vascular endothelial growth factor (VEGF) inhibitor or vitrectomy/scleral buckling, or a combination.



Incidence of ROP requiring treatment.



We received 370 CRFs; 327 were included. Denominator from epidemiological data: 8112 infants with birth weight of <1500 g. The incidence of ROP requiring treatment was 4% (327/8112, 95% CI 3.6% to 4.5%). Median gestational age was 25 weeks (IQR 24.3-26.1), and median birth weight 706 g (IQR 620-821). Median age at first treatment was 80 days (IQR 71-96). 204 right eyes (62.39%) had type 1 ROP, and 27 (8.26%) had aggressive posterior ROP. Infants were also treated for milder disease: 9 (2.75%) right eyes were treated for type 2 ROP, and 74 (22.63%) for disease milder than type 1 with plus or preplus, which we defined here as 'type 2 plus' disease. First-line treatment was diode laser photoablation of the avascular retina in 90.5% and injection of VEGF inhibitor in 8%.



ROP treatment incidence in the UK is 2.5 times higher than previously estimated. 8% of treated infants receive intravitreal VEGF inhibitor, currently unlicensed. Research is needed urgently to establish safety and efficacy of this approach. Earlier treatment and increasing numbers of surviving premature infants require an increase in appropriate eye care facilities and staff.



NCT02484989.
NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
Gillian G W
GG
Adams
NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
Catey
0000-0002-0935-3713
C
Bunce
NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
Wen
W
Xing
Birmingham and Midland Eye Centre, Birmingham, UK.
Lucilla
L
Butler
Department of Paediatric Ophthalmology and Strabismus, St James' University Hospital, Leeds Teaching Hospitals, Leeds, UK.
Vernon
V
Long
Royal Aberdeen Children's Hospital, Aberdeen, UK.
Aravind
A
Reddy
NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.
Annegret H
0000-0002-7402-4350
AH
Dahlmann-Noor
D055011:Ablation Techniques; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D058449:Intravitreal Injections; D007834:Lasers; D008297:Male; D009885:Ophthalmology; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D012160:Retina / Q000473:pathology*; D012178:Retinopathy of Prematurity / Q000628:therapy*; D012720:Severity of Illness Index; D006113:United Kingdom; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
D042461:Vascular Endothelial Growth Factor A
NEONATOLOGY