Screening of retinopathy of prematurity (ROP) - clinical guideline

ROP is one of the few causes of childhood visual disability that is largely preventable. This evidence-based guideline has been updated by RCPCH in collaboration with Royal College of Ophthalmologists (RCOphth) and British Association of Perinatal Medicine (BAPM) in March 2022. Also available are a printable examination recording form, summary of recommendations and an information leaflet for parents and carers.

Alert - June 2024

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recently published UK-based case series has highlighted six cases of babies of 31+0 - 31+5 weeks' gestation who developed ROP requiring treatment over the six year period, 2017-23.

Guideline review and advice: RCPCH will reconvene the ROP guideline development group to review the current guideline in light of new evidence. This review may lead to a recommendation to amend the screening criteria. In the interim, neonatal units with responsibility for screening for ROP should consider the above evidence when deciding which babies should undergo screening for ROP.

About ROP

Many extremely preterm babies will develop some degree of retinopathy of prematurity (ROP) with the majority of cases never progressing beyond mild disease, resolving spontaneously without treatment. However, a small proportion develop potentially severe ROP which can be detected through retinal screening. If untreated, severe disease can result in serious vision impairment and consequently all babies at risk of sight-threatening ROP should be screened on time.

About the guidelines

Cover of Screening of ROP clinical guideline

The guidelines are an update of the 2008 UK Screening and Treatment of Retinopathy of Prematurity, which was originally developed by RCPCH, RCOphth, BAPM and Bliss. This was reviewed in 2013 and subsequently updated in 2022. It will next be reviewed in 2027.

For the 2022 update, the topics were reviewed and are presented separately:

Screening of ROP

RCPCH updated this topic, including the below, which can be downloaded at the bottom of this page:

  • full guideline
  • summary of recommendations
  • printable examination recording form
  • parent and carer information leaflet (also available on a separate web page)
  • screening calculator to help plan timing of ROP screening appointment for eligible babies, with the National Neonatal Audit Programme (NNAP).

The RCPCH guideline is NICE accredited and developed in accordance with our guideline development process manual, Setting standards for development of clinical guidelines in paediatrics and child health (2020).

    Summary of changes to guideline on screening of ROP

    The guideline takes into account the significant changes in both the clinical and organisational aspects of neonatal care that have taken place over the previous 14 years.

    • Screening criteria: The gestational age criterion for screening was reduced from 32 weeks to 31 weeks as based on more recent published evidence. The birthweight criterion of less than 1501g has not changed. It is estimated that this will lead to a reduction in the number of babies needing screening of about 13%. (June 2024 - please see alert at top of this page.)
    • Timing of first examination: Precise timing of the first examination is stated.
    • Preparation for screening: Greater detail is included related to the preparation for screening, including consent, comfort care and pain relief during the screening examination. Our information leaflet for parents and carers has been fully revised.
    • Follow up examinations: When necessary, the importance of attending follow-up examinations is emphasised. The need for appropriate resuscitation equipment and trained staff is stated for outpatient examinations.
    • Referral to treatment: Details of when to refer for treatment are specified.
    • Record keeping and communications with others: There is emphasis throughout the guideline on record keeping and communication both with parents/carers and between professionals as well as the role of a ROP service coordinator.
    • Updated tools: A new algorithm for observations and a screening record form are included.
    • Comprehensive appendices: These give full details of the guideline scope, methodology and development.

      Treatment of ROP

      RCOphth updated this topic, including the below which can be found on the RCOphth website:

      • full guideline
      • executive summary
      • information leaflet for parents and guardians.

      summary article including both the screening and treatment guideline recommendations was published in the Early Human Development Journal in March 2023.

      You can get permission to reuse RCPCH published content quickly and easily.