Retinopathy of prematurity (ROP)

• All babies <31 weeks gestation or <1501g birthweight must be screened (see below for timing). 
• Enter baby’s details on admission in the front of the "eye" diary kept at reception. 
• Screening is done weekly. Those babies to be screened will have been entered by the ophthalmologists into the day diary. The ophthalmologists will phone and confirm time for screening and administration time for the eye drops. The drugs must be prescribed by a doctor or Advanced Neonatal Nurse Practitioner. 
• One drop Cyclopentolate 0.5% and one drop of Phenylephrine 2.5% are instilled into each eye 15 and 30 minutes before examination. A single minim can be used for both eyes but must not be used for more than one baby. 
• Prior to the procedure, the ophthalmologist will instil Benoximate 0.4% into the eye as a local anaesthetic. 
• The examination involves manipulation of the eye which can cause a bradycardia due to vagal stimulation. Unstable babies must be closely monitored during the procedure. 
• Frequency of screening will be decided by ophthalmologist and recorded in the diary and the clinical notes. 

The optimal timing of the first examination, based on birth gestation, is:

Decisions on whether an infant is too ill to examine will be made by discussion between the consultant ophthalmologist or deputy, and a neonatal consultant or deputy. Reasons NOT to examine will be documented.

The examination sequence will be: 

• Brief screening overview with speculum, scleral indentor and indirect ophthalmoscope. This will determine the zone of vascularisation (by examination of the nasal ora serrata), and the presence or absence of any ROP ridge. 
• In some clinical situations, related to anatomical access and quality of view, the RetCam may be used for the primary screen examination. 
• RetCam imaging. When ANY ROP is detected by indirect ophthalmoscope examination, RetCam images will be obtained in order to better stage disease, and record appearances. 

When infants have RetCam images taken, the doctor will leave a photography consent form for a parent to sign. The signed form will be kept with the nursing notes and retrieved later by the opthamolgist. The purpose is to obtain consent for anonymised retinal photographs that form part of the infant’s clinical record (stored on the RetCam) to be available later for teaching, observational research or audit, and publication.

• Include results of ROP screening in discharge letter. 
• If screening not yet started – make sure that discharge letter informs other hospital of date when screening should be done. 

If a baby is discharged into the community before completion of eye screening: 

• They will not be referred to the Eye Pavilion 
• They will not be referred to the Neonatal Outpatient Clinic for this screening 
• They will be brought back to the Neonatal Unit for the next available screening session 

On return to the unit the notes will be obtained, and prescription of the pupillary dilators carried out by medical staff.  The ophthalmologists will be informed about the child. 

The results will be documented as usual in the clinical notes by the ophthalmologist who will also dictate time and place of any subsequent appointments. 

Treatment  - click for guidelines