ROP: nonadherence to best practices leads to severe disability

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Takeaway

  • Many cases of severe disability from retinopathy of prematurity (ROP) in very preterm infants could have been avoided by guidelines adherence, according to this Swedish study. 

Why this matters

  • Most cases of severe disability from ROP might be avoided with adherence to guidelines.
  • Rates of ROP were relatively high, even in this high-resource setting.
  • In a comment, the journal editor-in-chief calls the study “both surprising and concerning” given Sweden’s “superb” medical care yet failures of guidelines adherence.
  • Editor asks: “what are implications for other countries?”

Key results

  • Severe disability could have been avoided in 11 of 17 children with ROP.
  • Most gaps leading to this situation occurred through lack of screening, a missed diagnosis, or suboptimal treatment.
  • 1 in 3 infants with ROP had delayed follow-up following a first treatment.
  • This value corresponds to 1 in 1000 very preterm infants and 1 in 77,000 live births.

Study design

  • Population-based, national cohort study, Sweden; 1,310,227 children born January 1, 2004 to December 31, 2015.
  • 17,588 born very preterm (
  • 17 had ROP and became severely disabled (visual acuity ≤20/200, both eyes).
  • Outcome: prevalence of severe visual disability.

Limitations

  • Retrospective, small affected population, single country.