Are Western ROP screening guidelines appropriate for middle–income countries? Lessons from pooled rural and urban data from the KIDROP study from Southern India

Anand Vinekar¹
Sherine Braganza¹
Praveen Sagar¹
Rohit Shetty¹
Clare Gilbert²
Bhujang Shetty¹

¹Department of Pediatric Retina, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India
²London School of Hygiene and Tropical Medicine, London UK.

Purpose: To compare the characteristics of babies requiring treatment for Retinopathy of Prematurity (ROP) from urban vs rural areas of Southern India.

Method: Retrospective analysis of infants who underwent screening (< 2000 grams birth weigh and/or < 34 weeks of gestation) and treatment under the Karnataka Internet Assisted Diagnosis of ROP (KIDROP) program. Rural infants were compiled from a data-pool of level I and II neonatal intensive care centres (NICU's) from six rural districts of Southern Karnataka and compared with selected level III NICU's from urban Bangalore city.

Results: Seventy-three rural and 88 urban infants underwent ROP laser treatment based on ETROP guidelines during the same period. A greater proportion of male infants received treatment in rural vs urban centres (63% vs 48%) (p < 0.05). The proportion of classical ROP and aggressive posterior ROP were comparable in the two cohorts (82% each and 17% each respectively). The median birth weights of babies receiving laser in rural vs urban was 1390 g and 1160 g respectively (p = 0.0002) and the median gestational ages was 31 and 30 weeks respectively (p = 0.02). Fifteen percent (15%) rural and 7.8% urban babies were outside the American screening cut-offs and would have been missed.

Conclusion: This is the first multicentre study from pooled rural centres from India that reports ROP characteristics. Western screening guidelines maybe inappropriate in the rural setting of middle-income countries like India, where heavier, more mature babies develop severe ROP.