• All babies either <1501 g birth weight or ≤30⁺⁶ weeks’ gestation 

When to screen

• If baby to be discharged before first screening due, bring eye examination forward to be seen before discharge

How often to screen

• If treatment not required after first ROP screen, screen weekly if any of the following are present:
  
  • vessels ending in zone I or posterior zone II with or without any stage of ROP
  • any plus or pre-plus disease
  • any stage 3 ROP in zone II or III
• Continue with weekly screening until criteria for 2-weekly screening or discontinuing screening are met

2-weekly screening criteria

• Vessels end in mid or anterior zone II or in zone III; AND
• No plus or pre-plus disease; AND
• No ROP, or stage 1 or 2 ROP
• Continue 2-weekly screening until criteria for treatment, weekly screening or stopping screening are met

When to stop screening

• If no ROP, continue until vascularisation has extended into zone III
  
  • if uncertainty about the zone, consider a further confirmatory examination 2 weeks later
• If any stage of ROP, continue until any characteristics of regression seen on ≥2 consecutive examinations: 
  
  • partial resolution progressing towards complete resolution 
  • change in colour of the ridge from salmon pink to white 
  • growth of vessels through the demarcation line 

How to screen

• Arrange screening with ophthalmologist

Preparation for screening

• Prescribe eye drops night before screening on drug chart
• Phenylephrine 2.5% and cyclopentolate 0.5%
  
  • instil 1 drop of each drug. Give 2 doses, 5 min apart, 1 hr before examination. Timings may vary according to Trust practice – check local guidance
  • if in any doubt whether drop has gone into eye, give another drop immediately (pupil must be fully dilated)
  • close eyelids after instillation of eye drops, wipe off any excess

Care during procedure

• A competent doctor/ANNP available during eye examinations
• Use comfort care techniques (nesting, swaddling +/- dummy). Parents to be offered opportunity to provide this
• Consider oral sucrose 0.1–0.5 mL before examination (maximum 3 doses), or breast milk
• Proxymetacaine 0.5% or oxybuprocaine 0.4% as topical anaesthesia just before examination when an eyelid speculum is to be used
• Avoid bright light and cover incubator/cot for 4–6 hr after examination

• Zone I with plus disease and with any stage of ROP 
• Zone I without plus disease but with stage 3 ROP 
• Zone II with plus disease and with stage 3 ROP 
  
  • zone II stage 2 with plus disease is borderline for treatment and may be treated or re-examined in 1 week or sooner 
• Plus disease should be present in ≥2 quadrants 

Discuss with treating ophthalmologist when referral warranted ROP is present:

• Any pre-plus or plus disease in ≥2 quadrants in any zone
• Any zone I or posterior zone II disease 
• Any stage 3 disease in any zone 

• Complete ad hoc ROP form in BadgerNet documentation
• Eye examination results and recommendations for further screening must be included in transfer letter, together with ophthalmological status, future recommendations for screening intervals and outpatient follow-up arrangements
• Subsequent examinations must be documented by ophthalmologist in baby’s medical notes

Offer parents information on ROP, available from https://www.rcpch.ac.uk/sites/default/files/2022-03/UK-screening-retinopathy-prematurity-information-parents-carers.pdf