Screening for retinopathy of prematurity.

The demise of retinopathy of prematurity (ROP) was confidently forecast in the 1950s when supplemental oxygen was identified as a causal factor. Unfortunately this did not transpire and by the mid-1960s it became all too apparent that ROP was not solely of historical interest. The purpose of this article is to consider screening for ROP working on the basis that at present this condition is not entirely preventable, and that despite meticulous neonatal care, serious and blinding disease still occurs.1 As in the past the ophthalmologist could neither prevent nor treat ROP, effectively all responsibilities for this condition, including its medicolegal aspects, rested with issues related to causation. The results of the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity have changed all that.24 After more than 20 years of inconclusive studies, retinal ablative treatment has been shown to significantly reduce the unfavourable outcome of severe disease, both in terms of the retinal appearance and visual function.24 Screening has now become a vital practical issue. In this article the nature of the preterm population will be briefly considered, after which certain aspects of ROP will be discussed such as: its classification, incidence and severity, natural history, and treatment. Against this background the concepts, and finally, the guidelines for screening will be considered. These were drawn up by a working party convened jointly by the College of Ophthalmologists and the British Association of Perinatal Medicine.5 Other than the guidelines themselves, the views expressed in this article are not necessarily those of the working party.