Retinopathy of prematurity screening criteria in Iran: new screening guidelines Ramak Roohipoor, 1 Reza Karkhaneh, 1 Afsar Farahani, 1 Nazanin Ebrahimiadib, 1 Bobeck Modjtahedi, 2 Akbar Fotouhi, 3 Mehdi Yaseri, 3 Alireza Khodabande, 1 Mohammad Zarei, 1 Marjan Imani Fuladi, 1 Arash Taheri, 1 Mohammad Riazi Esfahani, 1,4 John Loewenstein 2 1 Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran 2 Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA 3 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 4 Retina Service, Noor Eye Hospital, Tehran, Iran Correspondence to Professor Mohammad Riazi Esfahani, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Kargar Street, Tehran 1336616351, Iran; riazifahimi@yahoo.com Received 13 June 2015 Revised 14 February 2016 Accepted 29 February 2016 Published Online First 12 April 2016 ▸ http://dx.doi.org/10.1136/ fetalneonatal-2015-310129 To cite: Roohipoor R, Karkhaneh R, Farahani A, et al. Arch Dis Child Fetal Neonatal Ed 2016;101: F288–F293. ABSTRACT Objective To test the applicability of existing retinopathy of prematurity (ROP) guidelines on Iranian patients and to develop novel ROP screening criteria in Iran. Methods Both eyes of 1932 infants born ≤37 weeks of gestation and/or weighting ≤3000 g were included in this prospective cohort study that was conducted across nine neonatal intensive care units and a tertiary eye hospital ROP clinic. The patients were examined for ROP and the need for treatment (type 1 ROP or worse). All the patients were screened 4 weeks after birth or at 31 weeks of postmenstrual age, whichever was later. The patients were followed until retinal vascularisation was completed or the patients reached 50 weeks of gestational age (GA) without prethreshold ROP. A receiver operating characteristic curve was used to determine the best screening criteria for ROP. Screening criteria from other countries were applied to our patient data to determine their ability to appropriately detect ROP. Main outcome measure Patients with ROP requiring treatment. Results The mean GA±SD and birth weight (BW)±SD of the screened patients were 32±2.7 weeks and 1713 ±516 g, respectively. Using criteria of GA≤32 weeks or BW ≤2000 yielded sensitivity and specificity of 100% and 26.7%, respectively, for treatment requiring ROP regardless of clinical comorbidities. Using screening recommendations of American Academy of Pediatrics would miss 25.4% of ROP and 8.4%ROP requiring treatment in our cohort. Conclusions Other countries screening recommendations would result in a significant amount of missed cases of treatment requiring ROP when applied to Iran. As a result, we have proposed new guidelines for premature babies in Iran. INTRODUCTION Retinopathy of prematurity (ROP) is the leading cause of avoidable blindness in premature infants. 1 Blindness from ROP is an increasing problem in the low/middle-income countries resulting in the ‘third epidemic’. 2 The proportion of blindness due to ROP varies greatly among countries and is influ- enced by the nenonatal care as well as the availability of effective screening and treatment programmes. 3 Timely screening and treatment is critical to redu- cing unfavourable outcomes including blindness. 4 Severe ROP is increasingly seen in more mature infants in low/middle-income countries, especially when compared with their counterparts in devel- oped countries. It is recommended that each country develops and employs its own specific screening cri- teria appropriate for its local population. 4 The latest American Academy of Pediatrics (AAP) screening guidelines for ROP recommends mandatory screen- ing for infants with birth weights (BWs) ≤1500 g or gestational ages (GAs) ≤30 weeks. 5 These guidelines have been shown to be inadequate for screening in low/middle-income countries. 6–8 To date no screening criteria has been published for Iran. The aim of the present study was to evalu- ate the applicability of current different international ROP screening guidelines, including those of the AAP, and to develop ROP screening criteria that can provide a safe and efficient model for identifying babies who require ROP treatment. METHODS Institutional review board/ethics committee approval was obtained from the Farabi Eye Hospital. The study protocol adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained from the parents or guardians of the babies enrolled in the study. Patients were screened at nine neonatal intensive care units (NICU) in Tehran or in the Farabi Eye Hospital ROP Clinic (the largest ROP centre in Iran) after being referred from outside hospitals/NICUs in Iran between November 2012 and November 2013. What is already known on this topic Retinopathy of prematurity (ROP) appears in more mature babies in low/middle-income countries. It is highly recommended that every country develop its own ROP screening criteria. What this study adds By following the American Academy of Pediatrics guidelines (gestational age (GA) ≤30 weeks or birth weight (BW) ≤1500 g), 8.4% of Iranian ROP babies who required treatment would have been missed. Our revised screening guidelines, GA ≤32 weeks or BW ≤2000 g, result in 100% sensitivity for ROP requiring treatment in Iran. F288 Roohipoor R, et al. Arch Dis Child Fetal Neonatal Ed 2016;101:F288–F293. doi:10.1136/archdischild-2015-309137 Original article group.bmj.com on December 11, 2016 - Published by http://fn.bmj.com/ Downloaded from