Who should be involved in an ROP service?

To be effective across a health system, retinopathy of prematurity (ROP) services cannot be developed in isolation by individual clinicians and teams. They need to be co-ordinated nationally and across the multidisciplinary teams within hospitals which provide neonatal care.

Case study: How the UK’s national ROP programme evolved

In the early 1980s, a study found that fewer than 10 ophthalmologists were screening for ROP in the UK (Wilson et al. 2008). As ROP treatment outcomes improved it became apparent that screening guidelines were needed and in 1990 the first UK guidelines for ROP screening and treatment were jointly drawn up by the Royal College of Ophthalmologists (RCO) and the British Association for Perinatal Medicine (BAPM). These empowered more clinicians to begin ROP screening and treatment and, by the mid 1990s, about 180 UK ophthalmologists were screening for ROP. In 1996 the guidelines were revised and extended to cover treatment, parent information and counselling, and the management of end-stage ROP (RCO and BAPM 1996).

Treatment advances and new research led to a further review in 2008 by the Royal College of Paediatrics & Child Health in partnership with the RCO and BAPM. Also involved was a wide multi-disciplinary guideline development group of ophthalmologists, neonatologists, paediatricians, a paediatric anaesthetist, neonatal nurses and parents and representatives from the premature baby charity BLISS. The review led to the publication of new, evidence-based nationally accepted UK guidelines for health professionals caring for babies at risk of developing ROP (Wilson et al. 2008). The guidelines provide a framework from which multidisciplinary clinical teams can make decisions and they also support the UK ROP programme to evaluate its performance and plan for appropriate resources.

To ensure prompt screening, treatment and follow up support, ROP services in the UK are organised around neonatal teams, ophthalmic teams and parents. The guidelines set out how, for each baby, a consultant ophthalmologist initiates an integrated care pathway at the initial ROP screening and a named neonatologist then manages follow up.

To ensure good governance and evidence based care it is important that all national ROP guidelines and supporting management protocols are reviewed by all partners. The video on this step describes who needs to be part of the team to provide a high quality ROP service. As you watch, consider what the biggest challenge is for those ROP teams when, as is the case in many settings, national ROP guidelines and protocols have not yet been developed?