Current problems in the management of ROP.

Guidelines for screening for retinopathy of prematurity (ROP) and indications for treatment are well established, but implementation of screening and delivery of treatment may be problematical. We have performed a national survey of 118 specialised units dealing with at risk neonates to audit current practice in Britain and to identify practical problems with screening and with treatment. A screening policy for neonates at risk is in practice at 97% of units, performed by consultant ophthalmologists in 86% of centres. Units referred to specialised treatment centres in 23% of cases. An average of 54 infants at risk of ROP were screened by each of 118 units throughout Britain in 1993, and approximately 3% of these infants underwent treatment for ROP. Cryotherapy was used for treatment in 85% of units, laser photocoagulation in 51% and both treatment modalities were used in 36% of units. Less than 1/4 of the neonatologists polled were of the opinion that they should be trained to screen for ROP themselves. These results show that the screening guidelines have been successfully implemented in Britain, but demonstrate a wide variation in practice. Problems with screening and treatment are discussed.