The World Health Organization says that India and other middle-income countries are facing the third epidemic of ROP.
Extrapolating the government data (primarily from northern India) every two hours in India, three babies have reached the threshold for ROP treatment. Up to 24% of childhood blindness in India is due to retinal pathology and ROP is one of the most important cause. Prevention was never so better than cure when it comes to treating ROP.
There are multifactorial reasons for terming ROP as a pending epidemic. With the advent of improved facilities in Neonatal Intensive Care Units (NICU), preterm low/very low birth weight neonates now survive and are exposed to the risk of developing ROP. These babies who would not have survived otherwise in the past two decades, in small towns, are now surviving in greater numbers and many develop ROP.
The awareness of ROP among the medical fraternity is very low as a result of which the babies are referred to a retina specialist only late in the course of ROP. There are many myths among the paediatricians regarding ROP. One among them is that, babies who have never received supplemental oxygen therapy do not develop ROP. This myth has been busted now and it has been proved that supplemental oxygen therapy is not the only causative factor for ROP, though it plays some role. 20% of babies who never received oxygen in postnatal period still develop ROP.
As per the Western data, ROP occurs in babies who weigh less then 1500 gms. However in India, we tend to see ROP in babies who weigh more than 1500 grams. If we had applied the western criteria for screening babies, we would have missed 20% of the ROP cases. Western developed countries guidelines do not apply to Indian context as the neonatal and postnatal care vastly vary.
There is a tendency to see a large number of ROP cases in the rural areas in India,probably due to neonatal care practices prevalent there. Gestational age or post conceptional age as a screening tool is ineffective in rural area as it is almost impossible to date the pregnancy. ROP once diagnosed early is graded according to the set guidelines and treatment initiated as per protocol.
Early treatment of ROP can go a long way in preventing blindness. ROP can be effectively managed with laser photocoagulation. The immature retina in a pre-term neonate when exposed to very high concentration of ambient oxygen is susceptible to develop new blood vessels, which have a tendency to bleed. If the treatment is initiated early, these new blood vessels regress and the retina attains maturity subsequently. On an average for every 10 preterm neonates I screen, 4 would have ROP and among them 2 or 3 require treatment.
All this, calls for a clarion call among pediatricians; neonatologists and ophthalmologists who need to counsel the parents, screen for ROP more aggressively and to frame guidelines for screening Indian babies. Already there has been initiative in this context in the form of tele-ROP screening with help of Ret-cams, which can be transported to remote rural areas.
Hence with an extensive co ordination amongst neonatologists and Retinal specialists, and making ROP screening mandatory for Pre term babies, we can combat and prevent this avoidable blindness.
MBBS, DO, DNB (GoldMedallist),FRCS(Glasgow),FMRF(Sankara Nethralaya)
Apollo Specialty Hospital OMR