SD-OCT changes of the macula in mild ROP have not been previously described. Our method reveals that infants may be imaged supine and unanesthetized in the office. We hypothesize that these transient foveal changes at the critical time of fovealization in premature infants may influence their visual acuity in the adult life.

This is the first prospective ROP study from a district NICU in India and compares with previously published urban data. If Western-screening guidelines are used in the rural scenario, we risk a significant proportion of infants being missed who may require treatment.

The role of low platelets in the etiopathogenesis of APROP has not been previously elucidated. Our study shows that a platelet count of <100,000 was associated with severe disease. Recently, platelets have been reported to play a key role in angiogenic regulatory protein delivery. It is possible that premature infants who develop retinopathy of prematurity in the setting of low platelet counts may lack the function of either delivering the optimal level or incompletely scavenging the excess of vascular endothelial growth factor A present in APROP. The spontaneous resolution of disease in our index case with platelet correction alone needs additional studies to correlate the timing and magnitude of correction that may play a role.

REDROP demonstrates the feasibility of this low-cost method of enrolling unscreened infants into a ROP program. The cost of enrolling each infant was less than 5 rupees (US$0.10). Suggested strategies to improve use require multi-center validation.

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