Screening for retinopathy of prematurity in developing countries.

Improved survival of low birth weight, premature babies in India has increased the incidence of retinopathy of prematurity. Western reports describe screening criteria to pick up babies most at risk. However, our population of at-risk neonates is likely to be different, as most nurseries in India are not very well equipped. Our aim was to develop a screening strategy appropriate for our conditions. Ophthalmic records of 60 neonates with gestational age < or =35 weeks and/or birth weight < or =1500 g, born over a 1-year period, were retrospectively reviewed. Laterality, location and stage of retinopathy of prematurity were recorded. Age at detection, at threshold disease and at maximum stage was recorded, and progression or regression of retinopathy noted. The incidence of retinopathy was 13/60 (21.7%) and of threshold disease was 3/60 (5.0%). Threshold disease was never seen before 5.5 weeks PNA. Zone I disease invariably, zone II disease in 12.5% cases and zone III disease never progressed to threshold stage. Most (10/13; 76.9%) cases regressed without treatment. Screening for retinopathy should commence at 4 weeks PNA (post-neonatal age). Screening time, discomfort to the baby and complications can be reduced by examining temporal retina first. If normal, the nasal retina need not be examined. Also, babies with zone III disease need not be followed up to complete visualization. Retinal vascular dilatation, resistance to pupillary dilation and persistence of tunica vasculosa lentis can be indicators of intensive screening.