The U.S.A. eligible retinopathy of prematurity screening population 2003-2022: WONDER-ROP Study

Henry P Moshfeghi; Moosa Zaidi; Jochen Kumm; Sandra Hoyek; Celine Chaaya; Shannon D Scarboro; Edward Wood; Nimesh A Patel

doi:10.1016/j.earlhumdev.2025.106192

The U.S.A. eligible retinopathy of prematurity screening population 2003-2022: WONDER-ROP Study

Early Hum Dev. 2025 Jan 4:201:106192. doi: 10.1016/j.earlhumdev.2025.106192. Online ahead of print.

Authors

Henry P Moshfeghi¹, Moosa Zaidi², Jochen Kumm³, Sandra Hoyek², Celine Chaaya², Shannon D Scarboro⁴, Edward Wood⁴, Nimesh A Patel⁵

Affiliations

¹ Carleton College, Northfield, MN, United States of America.
² Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America.
³ Pr3vent, Inc, Palo Alto, CA, United States of America.
⁴ Austin Retina Associates, Austin, TX, United States of America.
⁵ Pr3vent, Inc, Palo Alto, CA, United States of America; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America. Electronic address: Nimesh_Patel2@meei.harvard.edu.

PMID: 39842136
DOI: 10.1016/j.earlhumdev.2025.106192

Abstract

Purpose: To delineate the trends of the United States population eligible for retinopathy of prematurity (ROP) screening as defined by the Joint Statement Screening Guidelines of the American Academies of Pediatrics and Ophthalmology from the Centers for Disease Control using the Wide-ranging Online Data for Epidemiologic Research (WONDER) Database.

Design: National, retrospective study.

Subjects: Infants with ROP in the United States between 2003 and 2022.

Methods: Data collected from WONDER database over the 20-year period 2003-2022.

Main outcome measured: The parameters of state, infant birth weight (BW), and last menstrual period estimated gestational age (EGA). Four categories of qualification for ROP Screening eligibility were created: BW, EGA, combined BW and EGA (double eligible infants), and Unique Eligible Infants (UEI).

Results: The number of eligible for ROP screening in the U.S peaked at 56,106 in 2007 and has steadily declined to 41,083 in 2022, averaging 47,088 per year throughout the study period. During the first ten-year period, there was an average of 50,895 eligible infants per year vs 43,281 infants per year during the second ten-year period. This was a statistically significant trend. BW slightly surpassed EGA as a driver for screening eligibility every year. Both the numbers of eligible micropremature (24-26 weeks GA and/or BW 600-800 g) infants and numbers of eligible nanopremature (<24 weeks GA and/or BW <600 g) infants mirrored the trendline overall eligibility trends. At the state level, Texas surpassed California in 2012 in terms of the highest number of eligible infants, and Florida surpassed New York in 2011 as the state with the third most eligible infants. These changes persisted until the end of the study period. State level changes were driven by EGA. For micropremature infants, California and New York demonstrated a decline in eligibility driven by both BW and EGA.

Conclusion: Consistent with a drop in overall births, the numbers of eligible infants for ROP screening at birth have been decreasing since its peak in 2007, with stabilization in the 2020's. Nationally, BW drives eligibility. Both micro- and nano-premature infants have decreased in a manner that corresponds to overall eligibility with nano-premature infants having a slight relative decrease. This data adds important context to studies on infant survivability and ROP screening epidemiology.

Keywords: Retinopathy of prematurity; Screening; Wide-ranging Online Data for Epidemiologic Research (WONDER) Database.