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Gilbert CE, Todd J. Impact of COVID-19 pandemic on retinopathy of prematurity services in low resource settings. Eye (Lond) 2024; 38:2102-2109. [PMID: 37880450 PMCID: PMC11269694 DOI: 10.1038/s41433-023-02784-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Retinopathy of prematurity is an increasingly important cause of blindness in children in low- and middle-income countries. Timely screening and treatment greatly reduce blindness. This study assessed the impact of the COVID-19 pandemic on ROP services in low- and middle-income countries. METHODS An online survey with closed and open-ended questions in Microsoft Teams was sent to 304 ophthalmologists providing screening, treatment and/or vitreoretinal services (January 15 to March 12 2021). Categories were used to report impact on services. 28 participants were purposively selected for interview. RESULTS 184/201 completed forms from 32 countries were received. Two thirds of participants worked in government facilities and 45.6% were paediatric ophthalmologists. A moderate to severe impact was reported by 13% for screening, 9% for treatment and 16% for vitreoretinal surgery with some variation between government, private and not-for-profit sectors. 22% thought services would take a year to recover. Fifteen ophthalmologists from 12 countries were interviewed. Many reported fewer neonatal admissions, and several reported more ROP blind infants once restrictions lifted. Themes associated with services continuing included limited lockdown, autonomy and flexibility, commitment, advocacy and technology. Themes associated with a negative impact include fear and panic, closure of facilities, COVID infection or quarantining of health workers and parents, lack of transport and exacerbation of poverty. CONCLUSIONS The COVID pandemic had a very variable impact on the provision of ROP services. In some countries where the impact was great, more infants may have become blind from ROP. Lessons can be learnt for planning pandemic preparedness.
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Affiliation(s)
- Clare Elizabeth Gilbert
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
| | - Joshua Todd
- Queens' College, University of Cambridge, Cambridge, UK
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Chakraborty S, Sheth JU. Impact of COVID-19 Pandemic on Retinopathy of Prematurity Services in the Indian Public Healthcare System. Clin Ophthalmol 2023; 17:2871-2877. [PMID: 37808002 PMCID: PMC10558049 DOI: 10.2147/opth.s426219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose To analyze the impact of the COVID-19 pandemic on the retinopathy of prematurity (ROP) services at Special Newborn Care Units (SNCUs), which provide care for sick neonates in the Indian public healthcare system. Methods A retrospective chart analysis of 508 babies screened for ROP at two SNCUs in West Bengal (India). We compared the data from the lockdown period (April, 2020-June, 2020; study arm) with the same period of the preceding year, 2019 (control arm). Results Out of the 508 babies, 187 were screened during the lockdown and 328 during 2019. The odds of developing ROP were 2.08 times (95% CI:1.25-3.48; P=0.002) higher during the lockdown period (35/187 babies; 18.72%) as compared to the previous year (34/328 babies; 10.37%). Also, the risk of sight-threatening ROP (ST-ROP) increased significantly during the lockdown (12/35 ROP babies; 34.29%) compared to the previous year (4/34 ROP babies; 11.76%) (odds ratio: 3.9; 95% CI:1.1-13.7; P=0.015). Notably, all babies with ROP during the lockdown presented more than 30 days after birth, compared to none in the previous year. All babies requiring laser therapy recovered completely in both groups. Conclusion An increased odds of developing ROP, including ST-ROP, was observed during the COVID-19 pandemic. Delayed ROP screening, which was noted in all study eyes, can have a detrimental effect on long-term visual prognosis. The findings of our research call for modifying the present healthy policy framework to make it more adaptable to disruptions in healthcare services, given the cyclical nature of the worldwide COVID-19 pandemic.
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Affiliation(s)
- Somnath Chakraborty
- Department of Vitreoretinal Services, Retina Institute of Bengal, Siliguri, India
| | - Jay Umed Sheth
- Department of Vitreoretinal Services, Shantilal Shanghvi Eye Institute, Mumbai, India
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Sahu SK, Mishra P. Challenge Accepted: Retinopathy of Prematurity (ROP) During COVID-19. Cureus 2023; 15:e35260. [PMID: 36968848 PMCID: PMC10035459 DOI: 10.7759/cureus.35260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
The World Health Organization has identified retinopathy of prematurity (ROP) as one of the emerging causes of preventable childhood blindness in developing and middle-income countries. It is becoming a major public health problem in developing countries like India and China. ROP blindness in India is increasing due to the highest number of preterm births in the world, suboptimal neonatal care, lack of awareness, screening programs and treatment not in place, and increasing numbers of neonatal intensive care units (NICUs) and special newborn care units (SNCUs) opening all over the country without appropriate ophthalmic care. On top of it, heavier and late preterm babies are developing severe ROP due to the variable quality of neonatal services and insufficient optimal eye care in the NICU and SNCU. The situation become more precarious during the coronavirus disease 2019 (COVID-19) pandemic, and it became a challenge to motivate health workers and parents to keep the screening and treatment of ROP babies in place.
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Scaramuzzi M, Maestri A, Campagnoli MF, Coscia A, Reibaldi M. Safety and tolerability of ozonated-oils in liposome eyedrop in preterm eye examination. Minerva Pediatr (Torino) 2022; 74:733-737. [PMID: 36239588 DOI: 10.23736/s2724-5276.22.07063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Eye examinations for ROP screening in preterm newborns are characterized by two main problems: infection control and poor tear secretion. Therefore, in order to reduce the risk of ocular infection and to protect the ocular surface, netilmicin eye drops are usually used after the exams. The purpose of our study was to evaluate the safety and tolerability of ozonated-oils eyedrops during the eye examination of preterm babies in the screening for ROP, sparing the use of antibiotics eyedrops. METHODS All newborn infants that needed to be screened for ROP were divided into two groups: in group A we used topical netilmicin eye drops and in group B ozonated-oils eyedrops. We looked for any sign of conjunctival injection and chemosis, infectious conjunctivitis, blepharoconjunctivitis, erythema, and edema of the eyelids. RESULTS A total of 162 adverse effects out of 3546 examinations (4,5%) were reported acutely: in group A (1778 examinations), they consisted of 47 reactive conjunctivitis, 3 cases of blepharoconjunctivitis, 30 of eyelids swelling, and 3 infectious conjunctivitis, compared to 39 cases of conjunctival injection, 3 blepharoconjunctivitis, 33 eyelids swelling and 4 infectious conjunctivitis in group B (1768 examinations). No significant differences were found in the comparison of the two groups. CONCLUSIONS Ozonated-oils eyedrops should be considered a valid and safe alternative for the lubrification of the ocular surface and an adjuvant strategy to further minimize the risk of microbial contamination during screening for ROP.
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Affiliation(s)
- Matteo Scaramuzzi
- Department of Ophthalmology, Città della Salute e della Scienza, Turin, Italy -
| | - Andrea Maestri
- Division of Neonatology and NICU, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Maria F Campagnoli
- Division of Neonatology and NICU, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Alessandra Coscia
- Neonatal Care Unit, Department of Public Health and Paediatric, University of Turin, Turin, Italy
| | - Michele Reibaldi
- Department of Ophthalmology, Città della Salute e della Scienza, Turin, Italy.,Department of Surgical Science, Eye Clinic, University of Turin, Turin, Italy
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Suhan DN, Singh A, Bhusal U, Panchal B, Agarwal K, Nayak S, Nayak S, Jayanna S, Das T, Jalali S, Jadhav VS, Padhi TR. Evaluation of a revised care plan for babies with retinopathy of prematurity during SARS-CoV-2 pandemic in India. Indian J Ophthalmol 2022; 70:2480-2484. [PMID: 35791139 PMCID: PMC9426158 DOI: 10.4103/ijo.ijo_133_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: To analyze the impact of a revised care plan for retinopathy of prematurity (ROP) during SARS-CoV-2 pandemic in a tertiary eye care facility in eastern India. Methods: In a retrospective study, we analyzed the medical records of babies managed for ROP during the peak of the SARS-CoV-2 pandemic, with particular reference to the challenges, and the revised strategies addressing travel restrictions for five months, from April to August 2020. The strategy included selective referral (babies with higher treatment probability), longer follow-up intervals (babies with non-alarming findings), use of locally available workforce, and teleconsultation whenever feasible. Results: In the given period, 222 babies were examined versus 624 in the preceding year (P = 0.001). The average gestational age, birth weight, and postmenstrual age at presentation were 30.4 weeks, 1.31 kg, and 37.7 weeks, respectively. The first examination was on time in 40.1% of babies but was delayed by a median of 23 days in the remaining babies. In the cohort, 56.7% of babies had any ROP, and 27.9% required treatment (versus 8.8% in the previous year; P < 0.001). The intravitreal anti–vascular growth factor (anti-VEGF) injection was more often used than in the previous year (n = 72 vs 36; P < 0.0001). The treatment outcome was comparable before and after the SARS-CoV-2 lockdown period. There was no report of health issues among the care providers attributable to ROP care. Conclusion: The revised strategy resulted in a smaller pool of babies screened but a larger proportion of babies treated for ROP. This strategy could be used more profitably in future ROP care.
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Affiliation(s)
- Dinesh Narayan Suhan
- Resident, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Avinash Singh
- Optometrist, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Utpal Bhusal
- Adjunct Optometrist, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Bhavik Panchal
- Faculty, Vitreoretinal Services, GMR Varalakshmi Campus, Visakhapatnam, India
| | - Komal Agarwal
- Faculty, Vitreoretinal Services, Kallam Anji Reddy Campus, Hyderabad, India
| | - Sameera Nayak
- Faculty, Vitreoretinal Services, Kode Venkatadri Chowdary Campus, Vijayawada, India
| | - Sameer Nayak
- Project Co-ordinator, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Sushma Jayanna
- Faculty, Vitreoretinal Services, Smt. Kannuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, Hyderabad, India
| | - Taraprasad Das
- Director, Newborn Eye Health Alliance, LV Prasad Eye Network, Bhubaneswar, India
| | - Subhadra Jalali
- Fellow, Vitreoretinal services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Vishal Sanjay Jadhav
- Faculty, Vitreoretinal services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Tapas Ranjan Padhi
- Faculty, Vitreoretinal services, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
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Huang CW, Yeh PT, Tsao PN, Chou HC, Chen CY, Yen TA, Huang HC, Lai TT. Validation of the Postnatal Growth and Retinopathy of Prematurity Screening Criteria in a Taiwanese Cohort. Am J Ophthalmol 2022; 237:22-31. [PMID: 34780799 DOI: 10.1016/j.ajo.2021.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To validate the performance of Postnatal Growth and Retinopathy of Prematurity (G-ROP) screening criteria in a Taiwanese cohort. DESIGN Screening evaluation with retrospective data. METHOD Premature infants who underwent retinopathy of prematurity (ROP) screening between January 2015 and April 2019 at a tertiary hospital were examined. Infants with known final ROP results and complete longitudinal weight records were included. G-ROP screening criteria, both original and simplified (G-ROP 180 g), were applied as the prediction model for type 1 ROP; sensitivity and specificity were analyzed. The reduction in the number of infants requiring ROP screening and the number of funduscopic examinations were calculated. RESULT A total of 303 infants with documented ROP outcomes and complete weight gain records were examined. Of these, 103 infants developed ROP, of whom 29 developed type 1 ROP, whereas the other 200 did not develop ROP. For the detection of type 1 ROP, the sensitivity and specificity of the original G-ROP screening criteria were 96.6% and 42.3%, and 100% and 31%, for the simplified G-ROP 180 g model, respectively. The reduction in the number of infants requiring screening and funduscopic examinations was 32.6% and 33.5% for the original G-ROP criteria, and 28.1% and 23.2% for the G-ROP 180 g model, respectively. CONCLUSION Both the original G-ROP and G-ROP 180 g criteria attained high sensitivities in detecting type 1 ROP in the current Taiwanese cohort, with the G-ROP 180-g model outperforming the original one. Validation and modification may be required before applying G-ROP screening criteria to different populations.
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Affiliation(s)
- Ching-Wen Huang
- From the Department of Ophthalmology (C.-W.H., P.-T.Y., T.-T.L.), National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ting Yeh
- From the Department of Ophthalmology (C.-W.H., P.-T.Y., T.-T.L.), National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics (P.-N.T., H.-C.C., C.-Y.C., T.-A.Y., H.-C.H.), National Taiwan University Hospital, Taipei, Taiwan; Research Center for Developmental Biology & Regenerative Medicine (P.-N.T.), National Taiwan University, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics (P.-N.T., H.-C.C., C.-Y.C., T.-A.Y., H.-C.H.), National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics (P.-N.T., H.-C.C., C.-Y.C., T.-A.Y., H.-C.H.), National Taiwan University Hospital, Taipei, Taiwan
| | - Ting-An Yen
- Department of Pediatrics (P.-N.T., H.-C.C., C.-Y.C., T.-A.Y., H.-C.H.), National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Chung Huang
- Department of Pediatrics (P.-N.T., H.-C.C., C.-Y.C., T.-A.Y., H.-C.H.), National Taiwan University Hospital, Taipei, Taiwan
| | - Tso-Ting Lai
- From the Department of Ophthalmology (C.-W.H., P.-T.Y., T.-T.L.), National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine (T.-T.L.), College of Medicine, National Taiwan University, Taipei, Taiwan.
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