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There is an alarming increase in the incidence of retinopathy of prematurity (ROP) in the developing countries including India today, constituting what is referred to as the third epidemic of ROP. While the incidence of ROP is on the wane in the West, thanks to the improvement in neonatal care and screening, in India we are just beginning to face the storm mainly due to increased awareness. The most important determinant of any ROP management program is an eff ective screening strategy. There are several peculiarities that preclude the application of the eff ective guidelines that exist in the West to the Indian scenario. Two questions: Whom to screen? And when to screen? have to be answered in the Indian scenario. Let us consider the Þ rst question of whom to screen? There is a geographic variation in the incidence of ROP in babies born at even similar gestational ages. 1 In the West, ROP at least of the threshold variety is not seen in higher birth weight (BW) babies! Therefore, larger babies generally are not screened since the incidence of treatable ROP is low and these infants have been observed to have a generally good outcome even without treatment. The American Academy of Pediatrics (AAP) recommends screening of infants born at ≤ 28 weeks gestational age (GA) and/or ≤ 1500 g BW (regardless of supplemental oxygen); 1500 to 2000 g BW if supplemental oxygen was administered and the infants had an unstable clinical course. 2 However, Wright et al. 3 recommended screening of all infants born at ≤ 32 weeks GA and/or ≤ 1500 g BW (regardless of supplemental oxygen) and predicted that it would lead to savings in excess of 1.5 million dollars annually in the United States; this was approved by Andruscavage et al. 4 A recent study from the US found that no infant with birth weight greater than 1500 g developed treatable ROP. 5 Similar guidelines exist in the UK as laid out by the Royal College of Ophthalmologists and the British Association of Perinatal Medicine. 6 In contrast, ROP is seen in larger, bigger BW babies in Asia and other developing countries. In south India, threshold ROP has been seen in babies born with 2000 g birth weight. 7 While partly this might reß ect the failure of very small infants to thrive, other factors such as perhaps the quality of neonatal care that …

Retinopathy of prematurity screening in the Indian population: It′s time to set our own guidelines!