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2022; Elsevier BV; Volume: 129; Issue: 6 Linguagem: Inglês

10.1016/j.ophtha.2022.01.026

1549-4713

Graham E. Quinn, Alastair R. Fielder, R.V. Paul Chan, Michael F. Chiang,

Neonatal and fetal brain pathology

We thank Agarwal et al for their letter about the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), in which they raise 2 important issues. The first issue relates to possible medicolegal implications. In preparing ICROP3, we fully recognized the great advances in neonatal care across the world. It was a fundamental tenet of the committee that no criticism was intended toward the care of these vulnerable infants. Aggressive ROP (A-ROP) occurs worldwide, with more than 70% of severe ROP in low and middle income countries.1Blencowe H. Lawn J.E. Vazquez T. Fielder A. Gilbert C. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010.Pediatr Res. 2013; 74: 35-49Crossref PubMed Scopus (356) Google Scholar Our sentence “aggressive ROP . . . is increasingly recognized also to occur in larger preterm infants and beyond the posterior retina, particularly in regions of the world with limited resources” highlights that A-ROP occurs not only in the smallest and sickest infants (as previously described), but also in larger infants (references 5 and 26 in the original publication). The phrase “limited resources” encompasses equipment, neonatal and ophthalmic personnel, as well as expertise—and is simply a statement of the current situation.2Mills A. Health care systems in low- and middle-income countries.N Engl J Med. 2014; 370: 552-557Crossref PubMed Scopus (280) Google Scholar,3Burton M.J. Ramke J. Marques A.P. et al.The Lancet Global Health Commission on Global Eye Health: vision beyond 2020.Lancet Glob Health. 2021; 9: e489-e551Abstract Full Text Full Text PDF PubMed Scopus (131) Google Scholar Furthermore, we recognize that although there are major differences among countries with regard to resources, these differences are also present within individual low-, middle-, and high-income countries.4Braveman P. Tarimo E. Social inequalities in health within countries: not only an issue for affluent nations.Soc Sci Med. 2002; 54: 1621-1635Crossref PubMed Scopus (171) Google Scholar,5Kim E.J. Marrast L. Conigliaro J. COVID-19: magnifying the effect of health disparities.J Gen Intern Med. 2020; 35: 2441-2442Crossref PubMed Scopus (49) Google Scholar The presence of A-ROP does not imply negligent care, and the specific issues pertaining to any particular infant would need to be analyzed regardless of which country it occurred in. In summary, we appreciate the interest and concerns expressed by Agarwal et al, but contend that the disease descriptions in ICROP3 have no medicolegal implications. The second issue raised by Agarwal et al is that the ICROP3 Committee should recognize the full range of morphologic manifestations of acute phase disease. They suggest that A-ROP very close to the optic disc should be referred to as “posterior zone I” or “half-zone.” Our committee considered this point in detail and felt that the clinical need to further subdivide zone I did not outweigh the additional complexity. Agarwal et al also suggest that other etiological descriptors (such as exudative vs tractional vs rhegmatogenous vs combined mechanism for retinal detachment) should be included in the classification. We agree that experience from around the world shows that the clinical features associated with acute phase ROP are far more extensive and subtle than previously thought. However, the ICROP3 Committee considers it important that, for now, these various manifestations of the acute phases of ROP should not be considered as distinct separate entities, but rather should be seen within the continuous spectrum of acute disease. Overall, our intent is for ICROP3 to help clinicians provide the best care for premature infants, while also building a foundation whereby future research studies will continue to advance the field. We thank the authors for raising these points, and look forward to research work that may provide a basis for ICROP3 to evolve in future revisions. Michael F. Chiang, Graham E. Quinn, Alistair R. Fielder, Susan R. Ostmo, R. V. Paul Chan Chair: Michael F. Chiang, MD (National Eye Institute, Bethesda, MD) aLead of imaging subcommittee. Vice Chair: Graham Quinn, MD, MSCE (Children’s Hospital of Philadelphia, Philadelphia, PA) bLead for acute phase subcommittee. Audina Berrocal, MD (Bascom Palmer Eye Institute, Miami, FL) Gil Binenbaum, MD, MSCE (Children’s Hospital of Philadelphia, Philadelphia, PA) Michael Blair, MD (University of Chicago, Chicago, IL) J. Peter Campbell, MD, MPH (Oregon Health & Science University, Portland, OR) Antonio Capone, Jr., MD (Associated Retinal Consultants; Oakland University, Rochester, MI) R.V. Paul Chan, MD (University of Illinois at Chicago, Chicago, IL) - Chair, International Pediatric Ophthalmology and Strabismus Council (IPOSC) ROP Committee Yi Chen, MD (China-Japan Friendship Hospital, Beijing, China) Shuan Dai, MD (Queensland Children’s Hospital, Brisbane, Australia) Anna Ells, MD (Calgary Retina Consultants, Calgary, Alberta, Canada) Alistair Fielder, FRCP (City, University of London, UK) cLead for regression/reactivation subcommittee. Brian Fleck, MD (University of Edinburgh, Edinburgh, Scotland) William Good, MD (Smith-Kettlewell Eye Institute, San Francisco, CA) Mary Elizabeth Hartnett, MD (University of Utah, Salt Lake City, Utah) Gerd Holmstrom, MD (Uppsala University, Uppsala, Sweden) Shunji Kusaka, MD, PhD (Kindai University, Osakasayama, Japan) Andrés Kychenthal, MD (KYDOFT Foundation, Santiago, Chile) Domenico Lepore, MD (A. Gemelli Foundation IRCSS, Catholic University of the Sacred Heart, Rome, Italy) Birgit Lorenz, MD (Justus-Liebig-University Giessen, Germany and University Eye Department, Bonn, Germany) Maria Ana Martinez-Castellanos, MD (APEC, Mexico City, Mexico) Susan R. Ostmo, MS (Oregon Health & Science University, Portland, OR) Şengül Özdek, MD (Gazi University, Ankara, Turkey) Dupe Ademola-Popoola, MD (University of Ilorin, Ilorin, Nigeria) James Reynolds, MD (Ross Eye Institute, University at Buffalo, Buffalo, NY) Parag K. Shah, MD (Aravind Eye Hospital, Coimbatore, Tamil Nadu, India) Michael Shapiro, MD (Retina Consultants, Des Plaines, IL) Andreas Stahl, MD (University Medicine Greifswald, Germany) Cynthia Toth, MD (Duke University, Durham, NC) Anand Vinekar, MD, PhD (Narayana Nethralaya Eye Institute, Bangalore, Karnataka, India) Linda Visser, MD (University of KwaZulu-Natal, Durban, South Africa) David Wallace, MD, MPH (Indiana University School of Medicine, Indianapolis, IN) Wei-Chi Wu, MD, PhD (Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan) Peiquan Zhao, MD (Xinhua Hospital and Shanghai Jiao Tong University School of Medicine, Shanghai, China) Andrea Zin, MD, PhD (Fernandes Figueira Institute, FIOCRUZ, Rio de Janeiro, Brazil) a Lead of imaging subcommittee. b Lead for acute phase subcommittee. c Lead for regression/reactivation subcommittee. Re: Chiang et al.: International Classification of Retinopathy of Prematurity: Third Edition (Ophthalmology. 2021;128:e51–e68)OphthalmologyVol. 129Issue 6PreviewWe read with great interest the article by Chiang et al.1 The authors have described modifications and new additions in the classification of retinopathy of prematurity (ROP). The committee has tried to address all major limitations of the previous international classification of ROP (ICROP) and has taken into consideration newer global knowledge, imaging, as well as treatment modalities which have changed the way we can evaluate and manage ROP. Full-Text PDF