From 7/1/90 to 6/30/96, 834 infants (I) admitted to the UTMC-K ICN were screened for ROP according to AAP guidelines [birth weight (BW) < 1800 g or gestational age (GA) < 35 weeks if exposed to supplemental oxygen]. Serial funduscopic exams, begun at 5-7 wks postnatal age, revealed no ROP in 479 I(57.4%), Stage 1 in 196 I(23.5%), Stage 2 in 86 I(10.3%), Stage 3(subthreshold) in 41 I(4.9%), Stage 3 (threshold) in 28 I(3.4%), and Stage 4 in 4 I(0.5%). The incidence of ROP<3 or >2 by GA and BW is shown below. No ROP > 2 was observed with GA > 31 wks or BW > 1500 g. All threshold and Stage 4 ROP were confined to I with GA < 30 wks or BW < 1200 g. If the BW cutoff were lowered to include I with BW <1700 g, < 1600 g, or < 1500 g, the number of I requiring screening would be reduced 18.1%, 24.7%, and 31%, respectively, with no loss of sensitivity for ROP > Stage 2. Similarly, were the GA criteria lowered to < 34 wks, < 33 wks, or < 32 wks, the number of I screened could likewise be reduced by 7.9%, 14.9%, and 26.9%. Our experience suggests that substantial savings might accrue from the use of more restrictive ROP screening guidelines while missing no cases of ROP > Stage 2. Figure

figure 1