Round Up on ROP: Experts Share Strategies to Prevent Retinopathy of Prematurity in Asia-Pacific

An international panel of ophthalmologists shed light and new findings on retinopathy of prematurity (ROP), an eye disease that can cause blindness in premature babies, in a symposium entitled “Challenges and Strategies to Reduce Burden of ROP Blindness – Asia-Pacific Perspective.”

To begin, Dr. Rajvardhan Azad from India presented an update on antivascular endothelial growth factor (anti-VEGF) in ROP and findings on an anti-VEGF study (RAINBOW Trial). Meanwhile, Dr. Peiquan Zhao from China shared findings on surgical management for advanced ROP. 

Dr. Zhao reckoned that for stage 4 ROP, laser is always used first; whereas for stage 5 ROP, the iris puncture technique and dry lensectomy technique can be employed.

On the other hand, Dr. Wei-Chi Wu from Taiwan, in his talk Non-contact Smartphone-based Fundus Imaging Comparing to Conventional Fundus Imaging in ROP concluded that RetCam had better image quality. Smartphone-based fundus photography showed moderate agreement for determining the presence or absence of plus disease. 

Some of the speakers presented their studies on ROP cases and screenings, methodologies, and results from their respective countries, namely India, Malaysia, Taiwan, and New Zealand. 

Some happy news from Hong Kong

Dr. Connie Lai presented the screening audits of 10-year demographic data at Queen Mary Hospital in Hong Kong, whereby ROP development rate and severity had decreased from 31% to 21% for stage 1 ROP, and from 9% to 4% for stage 3 and above

“We had about 505 cases. The mean gestational age is about 29 weeks, and the main body weight is about 1.2 kilograms. We are happy to know that 77% of our babies did not develop ROP, and the treatment rate was only about 2.9%,” shared Dr. Lai, adding that some cases of infants from Macau were transferred to Hong Kong. 

She said during the COVID-19 pandemic, when Hong Kong was closed off to the world, some urgent ROP cases were transferred to Zhuhai, China.

ROP cases in New Zealand

Dr. Cheefoong Chong focused on the national database of New Zealand childhood visual impairment that was published in 2012. The database showed that 4.5% of premature infants born in New Zealand had ROP, and 0.7% to 1.44% of premature infants born in New Zealand require treatment for ROP.

“ROP is the second most potentially preventable cause of vision loss in New Zealand children,” he said, adding that 0.8% of New Zealand live births are <30 weeks GA (gestational age) or <1250g) of these children, up to 1.44% of them, will require treatment for ROP.

International comparison of ROP grading

Dr. Michael Chiang from the United States shared the study International Classification of ROP, 3rd Edition (ICROP3): Key findings and Implications, which he undertook with 34 other contributors. 

“Standard disease classification is essential for advancing clinical care and research. The study is an international comparison of ROP grading performance within the benefits of Oxygen Saturation Targeting II trials,” he said.

He then highlighted some key changes in ICROP3 and the future implications and clinical significance of the following:

  • Posterior zone II (intermediate category of 2 disc diameter beyond zone 1) and Notch (incursion of 1-2 clock hours into a more posterior zone)
  • Stage 5 disease that has been divided into 5A, 5B, and 5C, and their surgical approaches to long-term prognosis
  • Vascular spectrum (normal to plus) with the implication of AI, quantitative methods, and clinical significance
  • Aggressive ROP, which replaces APROP, and the clinical significance of flat neovascularization
  • ROP regression and how to manage persistent vascular retina (PAR)
  • ROP reactivation and how to manage and treat it

“Our goal is to improve quality and standardization of ROP care worldwide, and provide a foundation for improving clinical care and research in the future,” Dr. Chiang concluded.

Editor’s Note: The 38th Asia-Pacific Academy of Ophthalmology Congress (APAO 2023) was held on February 23 to 26 in Kuala Lumpur, Malaysia. Reporting for this story took place during the event. A version of this article was first published in Issue 2 of the APAO 2023 Show Daily.

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