AAO 2023: TWO-ROP algorithm: Simplifying the screening process

(Image Credit: ©PixAchi - Adobe.Stock.com)

Reviewed by Nimesh A. Patel, MD

Investigators from Massachusetts Eye and Ear (MEE) Boston, and the Bascom Palmer Eye Institute, Miami, have proposed a new algorithm, TWO-ROP, which they describe as “a new and simple screening protocol with a two-tiered impatient and outpatient approach.” Nimesh A. Patel, MD, who is from MEE, described the algorithm at the American Academy of Ophthalmology annual meeting in San Francisco

The idea behind this was to evaluate neonates with retinopathy of prematurity (ROP) who met only 1 screening criterion with the goal of easing the burden of ROP screening.

Patel enumerated the 3-fold need for the new algorithm: “ROP screening is becoming an increasing challenge, current advanced algorithms are limited by lack of readily accessible inputs as well as their reliance on outdated datasets, and ROP may be over-screened in developed countries in the modern era.”

The current ROP screening guidelines apply to babies with a birthweight under 1,500 grams or a gestational age less than 30 weeks. Inpatient screening is undertaken 4 weeks after birth or at 31 weeks, whichever is later, he explained.

Changing the screening focus

(Image Courtesy of Nimesh A. Patel, MD)

The investigators assessed the rates of ROP and treatment-warranted ROP in patients who met only 1 of the current screening criteria, that is, patients who satisfied only the birthweight or gestational age criterion. The study aim was to determine the outcomes if the screening requirement was changed, such that patients met both criteria.

This idea is supported by the low rates of ROP seen when patients were subdivided by gestational age and birthweight, ie, 30 weeks or longer gestational age/birthweight under 1,500 grams, less than 30 weeks gestational age/birthweight 1,500 grams or more, and 30 weeks gestational age and longer/birthweight of 1,500 grams or more. These 3 groups, respectively, had rates of ROP of 4.29%, 4.35%, and 1.07%.

Among the 33 patients, 28 with stage 1 ROP and 5 with stage 2 ROP, none required treatment.

New proposal

The new algorithm would require that patients satisfy 2 criteria undergo screening. “The goal is to decrease inpatient ROP screening while maintaining safety,” Patel said.

He pointed out that based on the data mentioned above, 12% of examinations would be eliminated. This challenges the idea that patients need to be screened on an inpatient basis or not at all.

The layer of safety in the algorithm proposes that for babies satisfying 1 criterion, outpatient screening can be conducted within 1 week of hospital discharge or for inpatients at 40 weeks of gestational age.

The investigators concluded, “Patients who met 1 of the current screening criteria had low rates of ROP and did not require treatment.The new and simple screening protocol is proposed with a 2-tiered inpatient and outpatient approach, ie, TWO-ROP.”

They advised that the algorithm requires external is required and planned.