1. Retinopathy of Prematurity: A Neglected Public Health Issue Krishnendu Sarkar Professor Regional Institute of Ophthalmology Kolkata

2. Retinopathy of prematurity (ROP) is a disorder of the developing retinal blood vessels in the premature & preterm infant retina. The key pathological change in ROP is peripheral retinal neovascularisation. This may regress completely or leave sequelae from mild myopia to bilateral total blindness.

3. Improved neonatal intensive care, improved survival rate of very premature babies, ROP is emerging as a significant cause of avoidable severe visual disability in children in developing countries like India. ROP, if not treated in time, causes irreversible blindness. Screening of low-birth babies is essential to detect ROP.

4. In India, of the 27 million live-births, approximately 9% are born below 2000 grams, the potential ‘at-risk’ population for ROP. 0.2% of childhood blindness in India is because of ROP. The prevalence ranges from 0.81/1000 to 1.5/1000 in different states. The incidence of ROP in neonatal intensive care units (NICUs) or referral to tertiary care hospital in India ranged from approximately 21- 40%.

5. The emerging epidemic of ROP blindness in India is the result of high birth rate, high rate of preterm births increasing provision of neonatal intensive care services with improving neonatal survival, lack of quality neonatal services, lack of awareness even among care-givers inadequately trained man-power for screening and treating ROP, most of whom are located in the large cities.

6. ROP is a multifactorial disease The risk factors for the increased ROP cases  short gestation  low birth weight  sepsis  intra-ventricular hemorrhage  exposure to light  blood transfusions  mechanical ventilation.

7. Factors, which affect the timely detection and treatment of ROP  compromised neonatal care due to limited and lack of resources  lack of awareness  lack of skilled personnel  financial constraints  lack of screening and treatment programs in the neonatal units.

8.  The blindness from ROP can be prevented by good screening program of early detection and timely intervention  Data indicates that general Ophthalmologists as well as non-Ophthalmologists (pediatricians and nurse practitioners) are independently reliable in detecting posterior pole changes in ROP babies, using direct ophthalmoscope and therefore can be provided with a screening protocol  This shows that given adequate training, general as well as non-Ophthalmologists can appropriately refer cases of ROP needing treatment.

9.  In India, more than 71.3% of the deliveries in low socio-economic status are home based in unhygienic conditions, majority by unskilled workers. A great number of newborns are either premature or low birth weight  Health-care institutes both in public and private sectors have well-equipped NICUs, but screening and diagnosis of ROP is not routinely being done in all.

10. 100% of the pediatricians were aware of the neonatal complications and ROP in preterm babies, A large percentage (34%) of them were not screening for ROP at all. Among those who arranged for screening of neonates routinely, referral in accordance with Indian standard guidelines was observed only in 25% of the respondents (period of gestation ≤ 34 weeks and birth weight ≤ 1500g and postnatal eventful clinical course). More than 50% pediatricians attended> 5 premature babies per week, the overall percentage of pediatricians arranging for ROP screening stands at 64% and the effective number following standard guidelines is a mere 14.5%. This underscores the important role pediatricians can play in identifying predisposed children and preventing ROP at appropriate time.

11. Conclusion  The Screening for “threshold” ROP has become obligatory following the confirmation of a significant benefit from treatment.  ROP awareness be increased by incorporating this component in national programs dealing with maternal and child health  More data has to be generated from both public and private sectors to have an accurate estimate of its burden  The competency of health-care providers and physicians has to be increased via training  Though, the guidelines for assessment of ROP were generated by WHO long back, but a wave of awareness of ROP has to be created before formulating some guidelines for its assessment in India

12. Thank you for your attention