Epidemiology of ROP update – Africa is the new frontier

Gilbert, Clare; Malik, Aeesha N J; Nahar, Nazmun; Das, Sanjoy Kumer; Visser, Linda; Sitati, Sarah; Ademola-Popoola, Dupe S

doi:10.1053/j.semperi.2019.05.002

Cited by 52 publications

(27 citation statements)

References 19 publications

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“…Other retinovascular diseases worthy of note were hypertensive retinopathy (which has been previously reported on in the region), 16,17 retinopathy of prematurity (an emerging retinal disease of increasing importance in the region), [18][19][20] sickle cell retinopathy (proliferative and nonproliferative disease), and retinal artery occlusion. A significant number of these renovascular conditions are associated with systemic risk factors such as diabetes, hypertension, dyslipidemia and sickle cell hemoglobinopathy, which occurred as co-existing systemic disease in a significant number of study patients.…”

Section: Discussionmentioning

confidence: 88%

Profile, Visual Presentation and Burden of Retinal Diseases Seen in Ophthalmic Clinics in Sub-Saharan Africa

Nkanga

Adenuga

Okonkwo

et al. 2020

OPTH

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Purpose: To determine the burden of retinal diseases and the degree of visual impairment associated with each disease, amongst Nigerians. Patients and Methods: This was a hospital-based multicenter, prospective, cross-sectional, non-comparative study conducted from January to December 2018. Data was obtained from consecutive patients with a retinal diagnosis presenting at the general ophthalmic and specialty retina clinics in four hospitals (three public, and one private teaching eye department) in Nigeria. Biodata, visual acuity and refraction, intraocular pressure, findings on dilated retinal examination, diagnosis and systemic diseases were noted. Degree of monocular and bilateral visual loss associated with each diagnosed retinal disease was summarized and p value was calculated using chi-square test. P < 0.05 was considered significant. Results: Eight hundred seventy-six of 8614 patients had a retinal diagnosis; establishing a hospital-based retinal disease prevalence of 9.8%. Male:female ratio was 1.1:1. The mean age of study patients was 49.97 (standard deviation 17.64 years). Mean symptom duration was 21.63 months (standard deviation 41.94). The mean intraocular pressure was 13.87 mmHg. Forty-three different retinal diseases were diagnosed. The most common was retinal complications of diabetes, i.e., diabetic retinopathy (DR) alone, diabetic macular edema (DME) alone and a combination of DR and DME, which accounted for 13.7%, 5.6% and 9.3%, respectively (contributed 28.6% of the entire diagnosis). This was followed by retinal detachment (RD), in 219 eyes (15.4%), dry age-related macular degeneration (AMD) in 124 eyes (8.7%). Nearly half of the eyes were blind or severely visually impaired. Blindness occurred in 34.1% of eyes; severe visual impairment in 8.2% of eyes and 29.7% had normal vision. There were 469 patients who had systemic diseases. The common systemic diseases were hypertension in 169 patients (19.3% of the total number of patients), hypertension and diabetes in 156 patients (18%), and diabetes alone in 98 patients (11.1%). Sickle cell disease was present in 1.5%. Conclusion: There is need to invest in infrastructure, local training and development of systems for early detection and treatment of several retinal diseases in sub-Saharan Africa; DR and DME having the largest burden. Collaborative physician care and management of hypertension and diabetes could significantly reduce the burden of DR and DME.

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Section: Discussionmentioning

confidence: 88%

Profile, Visual Presentation and Burden of Retinal Diseases Seen in Ophthalmic Clinics in Sub-Saharan Africa

Nkanga

Adenuga

Okonkwo

et al. 2020

OPTH

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“…In high-income countries, ROP is now mainly diagnosed in extremely preterm infants [4]. In low- and middle-income countries, improved survival of preterm infants has led to the third epidemic of ROP with an increased incidence of blindness in the pediatric population [5].…”

Section: Introductionmentioning

confidence: 99%

Screening for Retinopathy of Prematurity in Very Preterm Children: The EPIPAGE-2 Cohort Study

et al. 2021

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Introduction: Retinopathy of prematurity (ROP) is a blinding disease that requires screening by retinal examination. Screening practices are rarely evaluated. We aimed to determine the prevalence of ROP screening in very preterm infants and individual- and center-related factors associated with ROP screening. Methods: Data were extracted from the EPIPAGE-2 cohort, a French prospective population-based study of premature births in 2011. Children born before 32 weeks’ gestation (WG) without severe malformation and alive at the recommended time for ROP screening were included. Outcome measures were achievement of ROP screening and compliance with recommended screening timeline. Individual- and center-related factors associated with both measures were studied using mixed models. Results: Among 3,077 eligible infants, 2,169 (70.5%) had a ROP screening, ranging from 96% at 24 WG to 50% at 31 WG. Large variability among units was observed. Individual characteristics associated with screening were low gestational age, low birth weight, severe bronchopulmonary dysplasia or neurological lesions, and transfer between neonatal units during the screening period. Odds of screening were higher in neonatal units using wide-angle imaging (odds ratio 2.65 [95% confidence interval 1.17–6.01]) but decreased in units without a local protocol for ROP screening (0.03 [0.01–0.09]). Among screened children, 1,641/2,169 (75.7%) were screened according to recommended timeline. Delayed screening was associated with low gestational age, severe bronchopulmonary dysplasia or necrotizing enterocolitis, and absence of local protocol for ROP screening. Discussion/Conclusions: In this large cohort study of infants born very preterm, almost one-third were not screened for ROP. Children most at risk for ROP were the best screened but often with delay. The higher compliance of neonatal units using wide-angle imaging systems supports its use.

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“…4 There is no study on outcomes of ROP development from the perspective of the ophthalmologist managing the disease in the real world where a change of oxygen saturation levels occurred following these publications. The current third epidemic of ROP 7 is a worrying trend for developing nations. Blencowe et al 8 stressed that 65% children who are visually impaired from ROP were from middle-income regions.…”

Section: Introductionmentioning

confidence: 99%

Comparative cohorts of retinopathy of prematurity outcomes of differing oxygen saturation: real-world outcomes

Choo¹,

Grigg

Barnes

et al. 2021

BMJ Open Ophth

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ObjectiveAn ongoing third epidemic of retinopathy of prematurity (ROP) is contributed largely by developing nations. We describe a cohort of infants in a single neonatal unit where two limits of oxygen saturation were administered, to show real-world outcomes from trend in neonatology for higher oxygen to improve survival.Methods and analysisThis retrospective, comparative study of prospectively collected data in an ROP screening programme included infants indicated by gestational age ≤32 weeks, birth weight <1501 g, ventilation for 7 days or requiring oxygen >1 month, who underwent dilated fundoscopic examination from age 4 weeks, every 2 weeks until full retinal vascularisation. Infants with ROP were examined weekly and treated where indicated. Data were divided into two epochs. Epoch 1 oxygen saturation targets were [88–92%], epoch 2 targets [90–95% (99%)] with allowance of increase to 20% for several hours after procedures. Outcome measures included development of ROP, treatment, mortality, sepsis and intraventricular haemorrhage.ResultsA total of 651 infants underwent examination between 2003 and 2016. The incidence of ROP in epoch 1 was 29.1% and epoch 2 was 29.3% (p=0.24). ROP progression doubled in epoch 2 (5 vs 11%, p=0.006), proportion of cases treated halved (14% vs 6%, p=0.0005), sepsis was halved (78.5% vs 41.2%, p<0.0001) and intraventricular haemorrhage doubled (20.2% vs 43.8%, p=0.0001) in epoch 2. Mortality was 4% and 0% in epochs 1 and 2, respectively.ConclusionIncidence of ROP did not differ, although ROP cases that worsened doubled with higher oxygen targets. ROP cases requiring treatment decreased, as did sepsis and mortality. Intraventricular haemorrhage cases doubled.

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Epidemiology of ROP update – Africa is the new frontier

Cited by 52 publications

References 19 publications

<p>Profile, Visual Presentation and Burden of Retinal Diseases Seen in Ophthalmic Clinics in Sub-Saharan Africa</p>

<p>Profile, Visual Presentation and Burden of Retinal Diseases Seen in Ophthalmic Clinics in Sub-Saharan Africa</p>

Screening for Retinopathy of Prematurity in Very Preterm Children: The EPIPAGE-2 Cohort Study

Comparative cohorts of retinopathy of prematurity outcomes of differing oxygen saturation: real-world outcomes

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