Predictive algorithms for early detection of retinopathy of prematurity

Acta Ophthalmol. 2017 Mar;95(2):158-164. doi: 10.1111/aos.13117. Epub 2016 Jun 20.

Abstract

Purpose: To evaluate sensitivity, specificity and the safest cut-offs of three predictive algorithms (WINROP, ROPScore and CHOP ROP) for retinopathy of prematurity (ROP).

Methods: A retrospective study was conducted in three centres from 2012 to 2014; 445 preterms with gestational age (GA) ≤ 30 weeks and/or birthweight (BW) ≤ 1500 g, and additional unstable cases, were included. No-ROP, mild and type 1 ROP were categorized. The algorithms were analysed for infants with all parameters (GA, BW, weight gain, oxygen therapy, blood transfusion) needed for calculation (399 babies).

Results: Retinopathy of prematurity (ROP) was identified in both eyes in 116 patients (26.1%), and 44 (9.9%) had type 1 ROP. Gestational age and BW were significantly lower in ROP group compared with no-ROP subjects (GA: 26.7 ± 2.2 and 30.2 ± 1.9, respectively, p < 0.0001; BW: 839.8 ± 287.0 and 1288.1 ± 321.5 g, respectively, p = 0.0016). Customized alarms of ROPScore and CHOP ROP correctly identified all infants having any ROP or type 1 ROP. WINROP missed 19 cases of ROP, including three type 1 ROP. ROPScore and CHOP ROP provided the best performances with an area under the receiver operating characteristic curve for the detection of severe ROP of 0.93 (95% CI, 0.90-0.96, and 95% CI, 0.89-0.96, respectively), and WINROP obtained 0.83 (95% CI, 0.77-0.87). Median time from alarm to treatment was 11.1, 5.1 and 9.1 weeks, for WINROP, ROPScore and CHOP ROP, respectively.

Conclusion: ROPScore and CHOP ROP showed 100% sensitivity to identify sight-threatening ROP. Predictive algorithms are a reliable tool for early identification of infants requiring referral to an ophthalmologist, for reorganizing resources and reducing stressful procedures to preterm babies.

Keywords: CHOP ROP; WINROP; RORScore; algorithms; retinopathy of prematurity.

Publication types

  • Multicenter Study

MeSH terms

  • Algorithms*
  • Early Diagnosis*
  • Female
  • Gestational Age
  • Humans
  • Incidence
  • Infant, Newborn
  • Italy / epidemiology
  • Male
  • Neonatal Screening / methods*
  • Ophthalmoscopy / methods*
  • ROC Curve
  • Retina / diagnostic imaging*
  • Retinopathy of Prematurity / diagnosis*
  • Retinopathy of Prematurity / epidemiology
  • Retrospective Studies
  • Risk Factors