A practical tool for ROP screening
In this step, we share a practical tool, the ‘ROP classification and decision making’ job aid. This downloadable infographic summarises what we have learned this week about the classification of ROP and is designed to be used to support decision making and communications during ROP screening. This tool can be used to explain to parents what is happens at the back of the eye in ROP and also how ROP progresses.
How to use the job aid
Use the job aid as a guide when noting your observations and making appropriate management decisions:
Which areas of the retina are affected? Use the Zones illustration
What are the key features? Use the Stages, Plus disease and Aggressive posterior ROP illustrations
Based on your answers to questions 1 and 2: What type of ROP do you see? What is the management decision? Use the illustrations for the Types of ROP illustrations
You may also find the job aid helpful to support discussions with colleagues, parents and carers.
In week 3 we will add more detail into the job aid on schedules for treatment and follow up.
Job aid: ROP classification and decision making
Zones of ROP
Stages of ROP
- Stage 1: Demarcation line between vascular and avascular retina
- Stage 2: Raised ridge
- Stage 3: Vascularised ridge
- Stage 4: Subtotal retinal detachment: 4a) Macular not detached or 4b) Macular detached (as shown)
- Stage 5: Detached retina: Total retinal detachment: 5a) Open funnel or 5b) Closed funnel (as shown)
Signs of ‘plus’ disease:
- Retinal vessels dilated and tortuous in all four quadrants
- Iris vascular engorgement (dilated)
- Poor pupillary dilatation
- Vitreous haze.
Signs of ‘pre-plus’ disease:
- Vessels dilated and more tortuous than normal.
Aggressive posterior ROP
- Prominent plus disease
- Ill-defined demarcation line
- Flat network of proliferating new vessels
- Difficult to differentiate between arterioles and venules
- Progression is not through classic stages 1 to 3.
Types of ROP to support management decisions
Type 1 ROP: High risk - treatment required within 24 - 48 hours
Zone I, stage 3 without plus disease
Zone I, any stage with plus disease
Zones I & II, stages 2 & 3 with plus disease
Type 2 ROP: Low risk - follow up screening required
Zone 1 Stage 1 or 2 without plus disease
Zone 2 Stage 3 without plus disease
© London School of Hygiene & Tropical Medicine CC BY-NC-SA 4.0