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Modification of Screening Criteria for Retinopathy of Prematurity in India and Other Middle-Income Countries Subhadra Jalali, MS, Jyoti Matalia, MD, Anjli Hussain, MS, and Raj Anand, MS PURPOSE: To determine the gestational age and birth weight of premature babies who developed vision-threat- ening severe retinopathy of prematurity. DESIGN: Prospective observational study of babies at risk of blindness due to retinopathy of prematurity. METHODS: Data pertaining to all babies who underwent laser treatment or surgery for acute retinopathy of pre- maturity and those who had cicatricial retinopathy of prematurity were prospectively collected. The gestational age and birth weight were evaluated to establish screen- ing criteria. RESULTS: In 120 babies, the mean gestational age was 29.6 weeks (range 26 to 36 weeks). The birth weight of 115 babies ranged from 710 to 2000 g (mean 1254.5 g, SD 280.8). Birth weight was not available for five babies. Only one baby had a gestational age of >35 weeks. CONCLUSIONS: Ocular morbidity related to retinopathy of prematurity was seen in bigger and more mature babies. This study provides a scientific basis for establishing screen- ing criteria for retinopathy of prematurity in South India and other middle-income countries. (Am J Ophthalmol 2006;141:966 –968. © 2006 by Elsevier Inc. All rights reserved.) R ETINOPATHY OF PREMATURITY IS AN AVOIDABLE cause of blindness. 1 Screening criteria have been determined in high-income countries, 2,3 but it is not known whether these apply to all populations of babies. We report a prospective case series to determine the ges- tational age and birth weight of premature babies who developed vision-threatening retinopathy of prematurity. This series included eyes requiring laser treatment or sur- gery, or both, or presenting with cicatricial retinopathy of prematurity (collectively called severe retinopathy of pre- maturity). The LV Prasad Eye Institute retinopathy of prematurity screening service and prospective data collection were set up in the twin cities of Hyderabad and Secunderabad in October 1999. The aim of the Twin Cities Retinopathy of Prematurity Study (TCROPS) was to identify risk factors for retinopathy of prematurity and for failure of treatment. The twin cities had approximately 80 neonatal intensive care unit (NICU) beds (data obtained from the company providing the incubators/warmers to the NICUs). A retina specialist trained in retinopathy of prematurity (S.J.) visited each participating NICU weekly for retinopathy of prematurity data collection, screening, and treatment ac- cording to standardized protocols. 4 All preterm babies who came to the institute directly were also included. Institu- tional review board approval was not required, because the data collected pertained to routine clinical care of preterm infants. Informed consent from one of the parents was obtained before the babies were examined or treated for retinopathy of prematurity. Data from October 1999 through December 2002 were analyzed. The characteristics analyzed included birth weight and gestational age of individual babies who devel- oped vision-threatening severe retinopathy of prematurity. These included eyes detected to have threshold retinopa- thy of prematurity, progressive prethreshold retinopathy of prematurity in zone I, retinopathy of prematurity stage 4A and beyond, and cicatricial retinopathy of prematurity causing macular pathology according to international clas- sification of retinopathy of prematurity. 2–4 The data en- tered into an Excel sheet were analyzed using the SSPS 11.0 software for Windows (SSPS Inc, Chicago, Illinois, USA). Out of the TCROPS database of 1083 babies screened for retinopathy of prematurity, 120 babies matched our inclusion criteria as having severe retinopathy of prema- turity. There were 68 males (56.7%) and 52 female (43.3%). The birth weight of 115 babies (Table) ranged from 710 to 2000 g (mean 1254.5 g, SD 280.8). Birth weight data were not available for five babies. The mean gestational age at birth (Table) was 29.6 weeks (range 26 to 36 weeks, SD 2.1). Sixteen (13.3%) of 120 babies had birth weights and gestational ages outside the United Kingdom and United States screening criteria 2,3 ; only one baby had a gestational age 35 weeks. Accepted for publication Dec 8, 2005. From the Smt Kannuri Santhamma Retina Vitreous Centre (S.J., A.H., R.A.) and Jasti V. Ramanamma Childrens Eye Care Centre (J.M.), LV Prasad Eye Institute, Hyderabad, India. This study was supported by the Hyderabad Eye Institute. Inquiries to Subhadra Jalali, MS, Smt Kannuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, LV Prasad Marg, Banjara Hills, Hyderabad 500 034, India; e-mail: subhadra@lvpei.org AMERICAN JOURNAL OF OPHTHALMOLOGY 966 MAY 2006