Dear Editor,We read with interest the article by Vinekar et al.1 Authors
deserve congratulations for highlighting an important aspect of
diagnosis and management of retinopathy of prematurity (ROP)
in an excellent manner. We have certain observations to make.Authors excluded babies with hydrops ′to avoid erroneously
exaggerated birth weight′. We feel even these babies should
have been included and analyzed. Mandal et al., found
overexpression of vascular endothelial growth factor in
a relatively large baby with unusual severity of ROP.2
Large babies for the age might have some pathology like
hepatosplenomegaly, hydrocephalus, hydrops (immune as
well nonimmune types) in addition to maternal and genetic
factors. Implications of these factors in the pathogenesis of
ROP need to be studied.According to them 11 babies (17.7%) with threshold or
worse ROP would have been missed had they applied
the guidelines recommended by the American Academy
of Ophthalmology (AAO). Authors screened babies with
birth weights 1700 g or less and gestational age 32 weeks
or less. According to AAO babies with a birth weight of
less than 1500 g or with a gestational age of 32 weeks
or less and selected babies between 1500 and 2000 g or
gestational age of more than 32 weeks with an unstable
clinical course and who are believed to be at high risk by
their attending pediatrician or neonatologist should have
retinal screening examination to detect ROP.3 It would have
been interesting to note the number of babies left without
screening using these guidelines.Yanovitch et al., in a study analyzed 259 infants with birth
weight 1250 to 1800 g. They identified risk factors for the
development of ROP in these large babies. They found that
all infants with birth weight >1500 g who developed ROP
had greater than or equal to two of these risk factors.4 A
similar strategy can avoid unnecessary examination and
at the same time can identify babies who are more likely to
have severe ROP.They found ′outborn′ as the most significant risk factor
for the development of ROP in these large babies. The
subgroup analysis of these ′outborn′ babies would have
given an insight into the factors that make them prone for
the development of ROP.