Operationalization of Retinopathy of Prematurity Screening by the Application of the Essential Public Health Services Framework

Abstract

BackgroundThe 10 Essential Public Health Services Model Challenges to Retinopathy of Prematurity (ROP) Screening and the Need for a Model to Evaluate Screening Methods ROP is one the leading causes of preventable childhood blindness in the world. 1 In 2010, an estimate of 184,700 preterm infants worldwide developed some degree of ROP, and of these, 53,800 developed visually impairing severe disease (Blencowe et al 2010). Improving the efficiency and efficacy of ROP screening processes, education, and awareness amongst providers and families are the most important tools to reduce visual morbidity over a child's lifetime. Countries all around the world have designed methods for making screening, education, and awareness affordable, efficient, and accessible. However, there is great variability among these screening programs based on regional trends in disease severity and variable access to infrastructure for screening, treatment, and neonatal intensive care. This programmatic review seeks to examine efforts in establishing ROP screening programs through the lens of a public health model to identify strengths of these programs, as well as areas for improvement. By collecting data and evaluating these programs through an objective model, public health experts, health care providers, and policymakers can get an overview of previous work in capacity building and ROP screening program development. With this information, they can use this model to identify the successes and challenges to implement screening programs that are tailored to the needs of a region. Model SelectionIn the process of selecting a model to evaluate the various screening programs, the Social Determinants of Health (SDH) model of 2020 was considered for evaluation. 2 This dynamic model addresses contributing factors of health inequities, though it limits evaluation in several areas which are a core part of ROP screening programs. The SDH model does not address material circumstances, behavior, biological, and psychosocial factors that contribute to ROP incidence and prevalence. In addition, it does not address the role of research in evaluating areas for future work. The Ten Essential Public Health Services (TEPHS) model, however, may address some of the potential limitations of the SDH model and includes social determinants of health inequities. 3 Therefore, after further consideration and evaluation, the Ten Essential Public Health Services Model was chosen for our analysis.

Validation of postnatal growth and retinopathy of prematurity (G-ROP) screening guidelines in a tertiary care hospital of Pakistan: A report from low-middle income country

“…Early detection and prompt intervention are crucial to prevent permanent vision loss from ROP [ 7 ]. In the US, standardized screening criteria according to the recommendations of American Academy of Pediatrics (AAP), America Academy of Ophthalmology (AAO), and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) includes babies with a gestational age (GA) of 30 wk or less or birth weight (BW) of <1501 gm [ 7 ]. However, research from LMICs indicates that 66% of infants weighing less than 1,250 gm and 82% of those under 1,000 gm developed ROP, with 9% requiring treatment [ 8 ].…”