ROP in Pakistan

ROP Pakistan

Neonatal care services have expanded and more premature babies are now surviving. Infant mortality rate (IMR) in Pakistan dropped to 61.3 per 1000 live births in 2012 from 82.5 per live births in 2000, thus Pakistan is now at the threshold for an epidemic of blindness due to ROP. There are only 2 published studies on ROP, both from Aga Khan University Hospital, with a very well equipped tertiary care NICU. In 2008, a retrospective analysis of 68 premature infants with birth weight < 1500 gm and gestational age < 32 weeks, had reported an incidence of 32.4% of any stage of ROP, with 20.6% with severe ROP. A later studied conducted prospectively at the same institute with a broader screening criterion i.e., birth weight ≤ 2000g and gestational age ≤ 35 weeks – any stage of ROP, showed that no ROP was seen in the 66/301 infants who weighed > 1500g at birth and/or were born at > 32 weeks of gestation. Using the standard screening criteria, there was an improvement with only 11.5% developing ROP, while stage 3 ROP requiring treatment were 8.1% of the cases as compared 20.6%, in the earlier study. These levels are now comparable to ROP outcomes in high income countries. There is still a severe lack of awareness of the disease, appropriate screening criteria, consequences of delayed or no treatment as well as a lack of expertise for the management of such babies. In 2010 a descriptive study conducted at 10 centers with highest delivery rates in Karachi showed that only 2 centers had a screening protocol for ROP in place, but which was not being followed. Only 2 out of the 15 pediatricians who were interviewed were aware that ROP can cause blindness .
( Ref.,2,14.pdf)


There is an urgent need for creation of appropriate screening and oxygen protocols, training of ophthalmologist to screen the infants, creation of close liaison between the NICU, ophthalmologist and parents, education for all care givers on the importance of ROP, to protect premature infants in Pakistan from permanent blindness. We propose the creation of a Pakistan Retinopathy of Prematurity Educational and Research Alliance (PROPERA). Initially, a few hospitals in 2 to 3 major cities should be involved. An ROP coordinator and an ophthalmologist for screening should be designated. An initial screening criteria and an Oxygen protocol should be followed at these sites. Data should be collected and transmitted to a central collection center weekly. Subsequently, the network should be expanded, by adding other centers, and additional cities. An annual ROP conference should be organized to include all health care individuals involved with management of infants at risk of ROP. Collected ROP data should be presented, deficiencies identified, creation of appropriate screening guidelines and formulation of a plan for the next year agreed upon. Individuals with experience and interest in ROP will be vital for the success of this endeavor to save the sight of our next generation.
( Ref.,2,14.pdf)