|LETTER TO THE EDITOR
|Year : 2008 | Volume
| Issue : 2 | Page : 166-167
Anand Vinekar1, Mangat R Dogra1, Tiakumzuk Sangtam1, Anil Narang2, Amod Gupta1
1 Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||16-Feb-2008|
Mangat R Dogra
Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vinekar A, Dogra MR, Sangtam T, Narang A, Gupta A. Authors' reply. Indian J Ophthalmol 2008;56:166-7
We thank Kumar et al. ,  for having shown interest in our article describing the profile of retinopathy of prematurity (ROP) in Asian Indian babies weighing greater than 1250 g at birth. 
We agree that systemic factors such as hepatosplenomegaly and hydrocephalus (both of which were analyzed as direct or indirect factors in our study) may be risk factors for ROP. However, the exclusion of hydrops in our study was done to maintain homogeneity of birth weight measure, while describing this 'heavy' cohort as it is well established that the ensuing congestive cardiac failure and fluid accumulation in these infants (immune or non-immune) overestimates their birth weight.
As mentioned, 11 babies (17.7%) had threshold or worse ROP in our study and these babies were either >1500 g or >32 weeks (i.e. outside the American screening criteria) and their characteristics have been detailed in Table 3 of the manuscript. 
Further, 12 infants (from both groups) were >2000 g of which four had threshold or worse disease. Until 2004, we used <1700 g and <32 weeks as screening cutoffs at our center and this missed 14.5% of babies with severe ROP. Since 2004, by extending the gestational age cutoff to 34 weeks, a retrospective analysis has shown that only 3.2% of threshold or worse ROP would be missed in the same population.
Our study aimed to highlight the risk factors associated with severe ROP, that could help the clinician strategize the screening of babies in this birth weight cohort, to create a 'sickness criteria' as suggested by Gilbert.  The three risk factors significant on multivariate analysis (outborn, respiratory distress syndrome and exchange transfusion) were identified as risk factors for developing threshold or worse ROP in heavier babies.
As mentioned 'outborn' babies were found to be at highest risk for developing severe ROP ( P < 0.001). Of the 30 outborn babies, 23 (76.6%) had threshold or worse ROP. The mean birth weight was 1610 g. The 23 eyes with Stage 5, were seen in these 'outborn' babies. After discussion with the referring pediatrician (of outborn babies), we found that none of the 'outborns' were subjected to formal ROP screening, suggesting 'no examination' or lack of facility for timely screening. This practice delayed the diagnosis of severe ROP. Besides, 83% of these infants had received oxygen without any monitoring. This is a common practice followed in many developing countries. 
Whereas the manuscript establishes ROP characteristics in heavy babies of our country, this calls for a more efficient strategy, which includes increasing awareness among ophthalmologists and neonatologists regarding severe ROP developing in heavier babies in our setting. We need a closer and urgent look at the risk factors and the screening cutoffs followed in India to reduce the blindness burden in these 'heavy' infants.
| References|| |
Kumar N, Wani VB, Al Sabti K. Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth. Indian J Ophthalmol 2008;56:166.
Vinekar A, Dogra MR, Sangtam T, Narang A, Gupta A. Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: Ten year data from a tertiary care center in a developing country. Indian J Ophthalmol 2007;55:331-6.
Gilbert C. Retinopathy of prematurity - 'the second lull'? Br J Ophthalmol 2001;85:1017-9.
Wagner RS. Increased incidence and severity of retinopathy of prematurity in developing nations. J Pediatr Ophthalmol Strabismus 2003;40:193.