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PEDIATRICS Vol. 114 No. 2 August 2004, pp. 490-491

COMMENTARY

The Early Treatment for Retinopathy of Prematurity Study: Better Outcomes, Changing Strategy

Dale L. Phelps, MD on behalf of the ETROP Cooperative Group

Department of Pediatrics,
University of Rochester School of Medicine and Dentistry,
Rochester, NY 14642

Abbreviations: ETROP, Early Treatment for Retinopathy of Prematurity • ROP, retinopathy of prematurity

The Early Treatment for Retinopathy of Prematurity (ETROP) study, published in December 2003, has demonstrated that earlier treatment of selected cases of prethreshold retinopathy of prematurity (ROP) at high risk to progress to retinal detachments gives better overall ROP outcomes than treatment at threshold severity of the disease.^1,2 It is another important step forward in controlling this devastating disorder; however, to reap these gains, our ophthalmologists and nurseries must refocus on the timely detection and treatment of advancing ROP.

In the ETROP trial, 60% of infants with prethreshold ROP were found to be at high risk for progressing to retinal detachment, and these were enrolled to have 1 eye treated within 48 hours while the other received conventional follow-up and treatment only if reaching traditional threshold. The early-treated eyes had fewer unfavorable outcomes at 9 months (14.5% poor grating acuity vs 19.5% in the conventional eyes, and 9.1% poor retinal outcomes vs 15.6% in controls), although all of the early-treated eyes had laser therapy and only 66% of the conventionally treated eyes went on to receive laser therapy (cryotherapy was used only rarely).

Fortunately, the selection criteria resulted in only a modest increase in the total number of infants who must be treated, selecting largely those who would have gone on to need treatment by conventional management anyway.² In a secondary analysis of this large database, a simplified revision of the indications for treatment was extracted, a great practical improvement over the computer-generated algorithm used to select the research subjects for the study.²

Careful reading of the methods used in the trial reveals that the impact on an intensive care units’ policy for repeat ROP examinations is very real. If follow-up does not occur as in the ETROP study, then some of the advantages may be lost. Therefore, consider the following schedule for infants who do not yet meet criteria for treatment:

Twice a week if there is type 2 ROP (see Table 1)

Zone II no plus, stage 3 (or with plus, stage 1)

Zone I no plus, stage 1 or 2

View this table: [in this window] [in a new window]   TABLE 1. Revised Indications for the Treatment of ROP

 
Every week if the infant is near type 2

Zone II no plus, stage 2

Zone I no ROP immature

Every 2 weeks if less concerning

Zone II no plus, immature or stage 1

Until we can prevent ROP, it behooves us to ensure that skilled and timely detection of ROP that needs treatment is offered to each of our recovering preterm patients. Neonatologists, ophthalmologists, discharge coordinators, and ROP coordinators will need to meet and plan their policy revisions.

	FOOTNOTES

 
Received for publication Jan 14, 2004; Accepted Jan 26, 2004.

Reprint requests to (D.L.P.) Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Box 651, Pediatrics, 601 Elmwood Ave, Rochester, NY 14642. E-mail: dale_phelps{at}urmc.rochester.edu

	REFERENCES

TOP REFERENCES

 

1. Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity. Arch Ophthlamol.2003; 121 :1684 –1696[Abstract/Free Full Text]
2. Hardy RJ, Palmer EA, Dobson V, et al. Risk analysis of prethreshold retinopathy of prematurity. Arch Ophthalmol.2003; 121 :1697 –1701[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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