Incidence and Risk Factors for Retinopathy of Prematurity in Northern Iran.

Dear Editor,

I read with interest the study by Alizadeh et al on the incidence and risk factors for retinopathy of prematurity (ROP) in northern Iran.[1] It is obvious that ROP, one of the most common causes of preventable blindness in preterm neonates, is emerging as a “third epidemic” in middle-income countries, including Iran. This is due to the increasing survival of preterm neonates, insufficient monitoring of oxygen saturation (SaO2) in most centers, and lack of an ROP screening guideline in most neonatal intensive care units (NICUs).[2] The authors mentioned that the relatively high incidence of ROP (20.6%) in their study, which was conducted in northern Iran, emphasized the importance of neonatal screening in the region.[1] I presume that the clinical implication of that recommendation should be cautiously interpreted. This presumption is based on the following three points.

First, the health problem to be screened in a given community must be sizable to merit screening. The nationwide prevalence of ROP in Iran is not yet known. Available data suggest a variable ROP prevalence in certain areas of Iran, such as Rasht (20.6%)[1] and Tehran (34.5%).[3]

Second, the cost of incorporating screening and treatment of ROP into NICUs is substantial, and adequate financial resources must be available to cover it. It has been found that the unit costs per newborn were US $18.00 for each examination, US $398.00 per treatment, and US $29.00 for training. The estimated cost of ROP diagnosis and treatment for all “at-risk” NICU infants was US $80.00 per infant. The additional cost to the Unified Health System for one year would be US $556,640.00 for an ROP program with 52% coverage, increasing to US $856,320.00 for 80% coverage, and US $1.07 million for 100% coverage.[4]

Third, the widely employed screening criteria for ROP recommended by the American Academy of Pediatrics might not be applicable in developing countries such as Iran, as larger and more mature babies are developing ROP. In fact, the criteria for screening preterm infants for ROP vary globally. Some countries may miss clinically indicated cases, while others may screen babies unnecessarily. After more information is gained, screening protocols covering larger, more mature infants should be designed specifically for developing countries.[5]

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Conflicts of Interest

There are no conflicts of interest.