PEDIATRIC OPHTHALMOLOGY (S ROBBINS, SECTION EDITOR) Retinopathy of Prematurity (ROP) in a Developing Economy with Improving Health Care Dupe S. Ademola-Popoola 1 & Tunji S. Oluleye 2 # Springer Science + Business Media New York 2017 Abstract Purpose The purpose of this study is to highlight the chang- ing pattern of retinopathy of prematurity (ROP) incidence with improvement in economy and health care in Africa, pointing out the challenges and recommendations for sustain- able, cost-effective screening and management. Recent Findings ROP was initially thought to be rare in some parts of Africa. Recent findings have shown this not to be true. Studies done over 2011–2016 reported the presence of any ROP stage in 12–52% of screened babies with the prevalence of treatable ROP at 2.9–9.8%. ROP-trained ophthalmologists available to screen with binocular indirect ophthalmoscope and manage babies are few. Awareness of this blinding dis- ease, disease screening, adequate follow-up, treatment issues, and physician competing duties are the major factors militat- ing against effective ROP programs. Summary Creating awareness and collaboration among stake- holders is urgently needed in most parts of Africa. Cost-effec- tive, regional ROP screening program across several contigu- ous states using a telemedicine approach with widefield retinal imaging by middle-level personnel is strongly advocated to best address the growing problem of ROP in many parts of Africa. Keywords ROP . Africa . Improving health care . Incidence . Regional screening program Introduction Africa is the world’ s second largest and second most populous continent after Asia; it has a population of about 1.216 billion (2016) people. Africa has 54 fully recognized sovereign coun- tries. It is geographically broadly divided into North Africa (Algeria, Libya, Mauritania, Morocco, Tunisia, and Egypt) which lies north of the Sahara and runs along the Mediterranean coast and the sub-Saharan regions of East, West, Central, and Southern African. Nigeria, Egypt, and South Africa have the most developed economies [1, 2]. Vision 2020—the right to sight initiative of the World Health Organization (WHO)—recognized retinopathy of pre- maturity (ROP) as a major cause of blindness in babies. The disease is however neglected in most blindness prevention programs in Africa. It is said to be rare in Sub-Sahara Africa by previous workers [3, 4]. The reason for the assumption of rare ROP was non-survival of preterm babies due to inade- quate facilities for neonatal care. However, with improving economy and health care, more babies are surviving in Sub- Sahara Africa. Retinopathy of prematurity is known to increase with im- provement in health indices and technology that allows more babies born early to survive. There are limited available pub- lications from Africa on the magnitude of the ROP problem. Some of the known risk factors include prematurity, low birth weight, use of supplemental oxygen, sepsis, anemia, respira- tory distress, poor weight gain, and multiple births have been well documented across the world. Recent studies have shown that ROP is indeed present in Africa (Table 1). It was also previously suggested that there may be a genetic influence This article is part of the Topical Collection on Pediatric Ophthalmology * Dupe S. Ademola-Popoola dupsyp@yahoo.com 1 Pediatric Ophthalmology, Strabismus and Oncology Services, Department of Ophthalmology, University of Ilorin & University of Ilorin Teaching Hospital, Ilorin, Nigeria 2 Retinal & Vitreous Unit, University College Hospital & College of Medicine, University of Ibadan, Ibadan, Nigeria Curr Ophthalmol Rep DOI 10.1007/s40135-017-0129-0