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Predictors of treatment-warranted retinopathy of prematurity in the SUNDROP cohort: influence of photographic features

  • Retinal Disorders
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Abstract

Purpose

The Stanford University Network for the Diagnosis of Retinopathy of Prematurity (SUNDROP) initiative—an ongoing telemedicine-based initiative for in-hospital screening of high-risk infants for treatment-warranted ROP (TW-ROP)—has been shown to be a safe, reliable, and cost-effective supplement to the efforts of ROP specialists. We utilized data collected in the SUNDROP initiative to determine demographic (birth weight, sex, multiplicity), weight gain, and ocular imaging (media haze, peripapillary atrophy, fundus pigmentation) predictors of TW-ROP.

Methods

This was a retrospective nested case-control study. Cases and controls were selected from a cohort of 843 low birth weight, premature newborns who survived to an estimated gestational age of 31 weeks and underwent screening through the SUNDROP initiative. Infants were screened at one of six neonatal intensive care units from December 1, 2005, to April 1, 2016. Cases (n = 37) were newborns with TW-ROP who underwent retinal ablative therapy. Two controls (n = 74) without TW-ROP were matched to each case by gestational age. One reviewer graded media haze, presence of peripapillary atrophy, and fundus pigmentation in images taken at the baseline exam for each newborn. The main outcome measure was association of TW-ROP with predictive factors.

Results

In the SUNDROP trial, 37 out of 843 (4.4%) newborns developed TW-ROP. In a multivariable model, birth weight (OR, 0.32; 95% CI, 0.15–0.70) was inversely associated with TW-ROP. In contrast to prior reports, we found no significant difference in sex, multiplicity, or fundus pigmentation at baseline exam in those with TW-ROP as compared to controls. High levels of media haze (>2, scale 0 to 5) were found in the majority of cases (67.6%, 25/37) and controls (65.7%, 44/67). Presence of peripapillary atrophy did not improve prediction of the development of TW-ROP compared to birth weight and weight gain rate alone.

Conclusions

The finding of high levels of media haze at baseline ROP screening exams is novel. This study supports the current model for detection of TW-ROP using birth weight, gestational age, and weight gain rate. We found no significant difference between newborns with TW-ROP and controls in baseline presence of media haze, fundus pigmentation or peripapillary atrophy.

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Acknowledgements

Many thanks to Julia Simard, Sc.D. and Rita Popat, Ph.D. who played critical advisory roles in study design and analysis. We thank Andrew Martin at the Stanford Center for Clinical Informatics who provided database design and management. The Research Electronic Data Capture (REDCap) database tool hosted by Stanford University is maintained by the Stanford Center for Clinical Informatics grant support (Stanford CTSA award number UL1 RR025744 from NIH/NCRR). The authors report no conflict of interest.

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  1. Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Drive, Palo Alto, CA, 94303, USA

    Cassie A. Ludwig, Margaret A. Greven & Darius M. Moshfeghi

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  1. Cassie A. Ludwig
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  2. Margaret A. Greven
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  3. Darius M. Moshfeghi
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Correspondence to Darius M. Moshfeghi.

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Funding

Funding for this project was provided in the form of a grant from the Giannini Foundation. Additionally, the project described herein was conducted with financial support for Cassie A. Ludwig from the TL1 component of the Stanford Clinical and Translational Science Award to Spectrum (NIH TL1 TR 001084). Neither sponsor had any role in the design or conduct of this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Ludwig, C.A., Greven, M.A. & Moshfeghi, D.M. Predictors of treatment-warranted retinopathy of prematurity in the SUNDROP cohort: influence of photographic features. Graefes Arch Clin Exp Ophthalmol 255, 1935–1946 (2017). https://doi.org/10.1007/s00417-017-3745-3

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