Mount joint effort for ROP screening across the country, say Ophthalmologists

While the Indian Retinopathy of Prematurity Society has launched a mission to protect the vision of preterm babies an article published in the Lancet Regional Health Southeast Asia in May has suggested a comprehensive approach that draws on lessons from the successful Global Polio Eradication Initiative GPEI to tackle ROP in IndiaThe article lsquoRetinopathy of prematurity in India what we can learn from the polio legacyrsquo sheds light on the challenges of tackling ROP in India which sees over 35 million preterm births annually It is authored by Dr Sam Athikarisamy and Dr Sanjay Patole from the University of Western Australia Perth and Dr Anand Vinekar of Narayana Nethralaya Bangalore and the founder and director of KIDROP Karnataka Internetassisted Diagnosis of ROP In a November 18 report midday outlined the risk of vision loss faced by preterm newbornsEye surgeon Dr Anand Vinekar coauthored the article on Retinopathy of Prematurity ROP which was published in Lancet Southeast Asia in MayThe Lancet article emphasises the impact of untreated ROP and proposes primary prevention measures like reducing preterm births improving neonatal practices and ensuring proper oxygen stewardship It also calls for more commitment and coordination from the government NGOs healthcare professionals including obstetricians paediatricians neonatologists and ophthalmologists and professional organisationsThe article highlights the role influential brand ambassadors can play in creating awareness about ROP It cites the example of the campaign against polio in India which roped in actor Amitabh Bachchan The article suggests lsquotask shiftingrsquo to create a suitable workforce as there are not enough ophthalmologists trained in ROP management in the country This model has been validated by KIDROP wherein nonphysicians have been trained to image and triage infants in rural outreach neonatal ICUsDr Vinekar envisions the future of ROP screening in India as a universal and standardised program led by paediatricians and neonatologists using innovative technologies telemedicine lowcost infant imaging cameras and artificial intelligence ldquoWith trained technicians and an accredited reading centre remote screening sites can receive credible diagnoses leading to timely interventions to prevent severe vision loss and blindnessrdquo Dr Vinekar saidThe KIDROP modelNarayana Nethralayarsquos KIDROP is a teleROP service developed in Bangalore which uses nonphysician imaging staff for ROP screening and providing treatment in places lacking specialists Trained imaging staff capture and interpret retinal images using a triaging algorithm and ROPtrained ophthalmologists review the images to provide reports and management decisions within 20 minutes The model enables rural families to access ROP specialists remotelyA publicprivate partnership with the Karnataka government KIDROP is currently one of the largest singlecentre ROP programs in the world having tieups with 152 NICUs Implemented across Karnataka the model has trained and mentored institutes nationally and internationally ldquoSo far more than 220000 screenings have been completed and over 4000 babies have been treated An economic impact study has found that the implementation of this model in other states with similar demographics could save over 100 million annually in blindnessrelated costsrdquo said Dr VinekarOn November 17 World Prematurity Day the KIDROP programme signed an MOU with the KLE Academy of Higher Education and Research KAHER and Jawaharlal Nehru Medical College Belagavi to expand the model in the district and to initiate screening in southern Maharashtra and GoaRisk factors for ROPAccording to Dr Vinekar a babyrsquos retinal vessels begin to grow intrauterine and complete only if the baby is born on or near the due date Premature birth means the development of the retina remains incomplete There is a risk of blood vessels that supply oxygen to the eyes not growing normally which can lead to ROP ldquoOther than premature birth at 34 weeks of gestation and low birth weight less than 2 kg other risks for these babies include the prolonged use of oxygen for their lungs sepsis blood transfusion jaundice low weight gain low platelets anaemia intraventricular haemorrhage etcrdquo said Dr Vinekar ROP screening within 30 days of birth and before being discharged is strongly recommended for preventionLack of visible symptomsAccording to Dr Vinekar there are no visible external signs of ROP when it first develops ldquoAs a result many parents do not get their babies screened on time In advanced stages there is a white reflex leukocoria at the centre of the pupil round black portion of the eye By the time there are signs at four to six weeks it is too late to save useful vision An untreated infant with advanced ROP will have poor vision poor eye contact with the parent abnormal shaking of the eyes nystagmus and often delayed milestonesrdquo Dr Vinekar said ldquoSubtle and early treatable changes in a babyrsquos retina can only be detected by a trained ROP specialist and better documented by widefield retinal imaging using special camerasrdquo Dr Vinekar said