Master, Doctor and Post-Doctor in Ophthalmology

Hospital de Clínicas de Porto Alegre

Universidade Federal do Rio Grande do Sul

João Borges Fortes Filho

ROPScore: a tool in the screening for ROP

ROPScore is a risk indicator for severe ROP

74 referencias internacionalesGoogle Scholar Citations 2020

Eckert GU, Fortes Filho JB, Maia M, Procianoy RS. Eye (London) 2012; 26:400-406.

2012 - Eckert GU et al: ROPScore in 317 VLBW < 1500g and/or < 32 wks GA

• ROPScore allowed the best time to start the screening and decreased thenumber of exams needed to detect a baby with ROP who needs treatment

• The number of exams required to detect severe ROP has been reduced by 53%

• Based on the set of risk factors for ROP that each patient individually presents• ROPScore allows a custom approach to the screening for ROP

ROPScore is a method of scheduling the 1st assessmentof the babies in the NICU and the others that follow

• Applied by the nurse only once in the 2nd week of life of the premature babybefore the 1st ophthalmological examination

• At the 1st examination, the ophthalmologist already identifies the risk for severe ROP

High risk for severe ROP

BW (Birth Weight) in grams 1380

GA (Gestational Age) in weeks 29

BLOOD TRANSFUSIONS Y/N ? by the 2ª weeks of life 0

USE OF MECHANICAL VENTILATION Y/N ? By the 2a weeks of life

0

BABY WEIGHT BY COMPLETED THE 2ª WEEK OF LIFE 2140

WEIGHT GAIN PROPORTIONAL TO THE BW

0,56

ROPScore 10,7

BW (Birth Weight) in grams 1250

GA (Gestational Age) in weeks 27

BLOOD TRANSFUSIONS Y/N ? by the 2ª weeks of life 1

USE OF MECHANICAL VENTILATION Y/N ? By the 2a weeks of life

1

BABY WEIGHT BY COMPLETED THE 2ª WEEK OF LIFE 1450

WEIGHT GAIN PROPORTIONAL TO THE BW

0,16

ROPScore 16,7

Low risk for severe ROP

MAIN RISK FACTORS FOR ROP

• LOW GESTATIONAL AGE• LOW BIRTH WEGHT• OXYGEN THERAPY IN MECHANICAL VENTILATION • BLOOD TRANSFUSIONS• POSTNATAL LOW WEIGHT GAIN

RISK FACTORS EASELY IDENTIFIEDBW (BIRTH WEIGHT) in grams 735

GA (GESTATIONAL AGE) in weeks 27

If baby used MECHANICAL VENTILATION ? YES or NO 1

If baby needed BLOOD TRANSFUSIONS ? YES or NO 1

BABY’S WEIGHT AT COMPLETED THE 2nd WEEK of LIFE 1010

WEIGHT GAIN PROPORTIONAL TO THE BW 0,37

ROPScore 18,2ROPScore = 24.985-0.004*C2-0.264*C3-1.222*C7+2.148*C4+2.248*C5

Excel Microsoft Spreadsheet

SENS = 96% (95% CI: 79% - 100%)ESP = 59% (95% CI: 54% - 63%)PPV = 11% (95% CI: 7% - 16%)

NPV = 99.6% (95% CI: 98% - 100%)

ROPScore < 14.5 Cutoff value for Severe ROP

NPV (negative predictive value) = 99.6% means the probability of a baby with ROPScore <14.5 will never develop severe ROP

SCHEDULLING SCREENING BASED IN THE ROPScore

Programación para los examenes oftalmológicos

ROPScore de Muy Bajo Riesgo (≤11.0)

IG 26 27 28 29 30 31 32Exame

4ª semana 30 31 32 33 34 35 36Exame

5ª semana 31 32 33 34 35 36 37Exame

6ª semana 32 33 34 35 36 37 38Exame

7ª semana 33 34 35 36 37 38 39Exame

8ª semana 34 35 36 37 38 39 40Exame

9ª semana 35 36 37 38 39 40 41Exame

10ª semana 36 37 38 39 40 41 42Exame

11ª semana 37 38 39 40 41 42Exame

12ª semana 38 39 40 41 42Exame

13ª semana 39 40 41 42Exame

14ª semana 40 41 42Exame

15ª semana 41 42Exame

16ª semana 42

Total de

Exames 2 2 2 2 2 2 2RISCO

MÁXIMO

EXAMINAR

SEMPRE

Programación para los examenes oftalmológicos

ROPScore de Más Riesgo (≥14,50)

IG 26 27 28 29 30 31 32Exame

4ª semana 30 31 32 33 34 35 36Exame

5ª semana 31 32 33 34 35 36 37Exame

6ª semana 32 33 34 35 36 37 38Exame

7ª semana 33 34 35 36 37 38 39Exame

8ª semana 34 35 36 37 38 39 40Exame

9ª semana 35 36 37 38 39 40 41Exame

10ª semana 36 37 38 39 40 41 42Exame

11ª semana 37 38 39 40 41 42Exame

12ª semana 38 39 40 41 42Exame

13ª semana 39 40 41 42Exame

14ª semana 40 41 42Exame

15ª semana 41 42Exame

16ª semana 42

Total de

Exames 3 3/4 3/4 3 3 2 2RISCO

MÁXIMO

EXAMINAR

SEMPRE

National Guidelines

1) Screening VLBW between the 4th and the 6th weeksof life.

2) Exams should berepeated accordingto the initialfindings

Padova 214 VLBWVerona 170 VLBWUdine 61 VLBW

445 VLBW were included

ROPScore100% Sensitivity for Severe ROP

ROPScore was tested in 3 cities in Italy in 2016

ROPScore was revised in Philadelphia in 2018

Severe ROP ROPScore ≥ 16 CI 95%

Sensitivity 95,4% 76 - 99,0

Specificity 87,2% 81,9 - 92,6

PPV 9,5% 45,5 - 73,6

NPV 99,2% 97,8 - 100

ROPSCORE DECREASED THE NUMBER EXAMINATIONS

ROPScore for Low Risk Babies

72%

2019 - New publications in Brazilian population

Why should I use the ROPScore ?

Because ROPScore is the best tool to assist in ROP screening

ROPScore(Brazil) 2012

BW < 1500gand/or

GA < 32 weeks

Transversal at completed the2nd week of life

andBefore the 1st examination

Excel WS

PopulationTested Weight Gain

PracticalUse

PN (PESO DO NASCIMENTO) em gramas 1250

IG (IDADE GESTACIONAL) em semanas 26

TRANSFUSÕES SANGUÍNEAS S/N ? até a 2ª semana de vida 1

USOU VENTILAÇÃO MECÂNICA S/N ? até a 2a semana de vida 1

PESO DO BEBÊ AO COMPLETAR A 2ª SEMANA DE VIDA 1450

GANHO DE PESO PROPORCIONAL AO PN

0,16

ROPScore 16,7

High Risk for Severe ROP

ROPScore is a customized assessment of each babyapplied once to the 2nd week of life

PN (PESO DO NASCIMENTO) em gramas 1350

IG (IDADE GESTACIONAL) em semanas 27

TRANSFUSÕES SANGUÍNEAS S/N ? até a 2ª semana de vida 0

USOU VENTILAÇÃO MECÂNICA S/N ? até a 2a semana de vida 1

PESO DO BEBÊ AO COMPLETAR A 2ª SEMANA DE VIDA 2040

GANHO DE PESO PROPORCIONAL AO PN

0,51

ROPScore 13,6

PN (PESO DO NASCIMENTO) em gramas 1380

IG (IDADE GESTACIONAL) em semanas 31

TRANSFUSÕES SANGUÍNEAS S/N ? até a 2ª semana de vida 0

USOU VENTILAÇÃO MECÂNICA S/N ? até a 2a semana de vida 0

PESO DO BEBÊ AO COMPLETAR A 2ª SEMANA DE VIDA 2140

GANHO DE PESO PROPORCIONAL AO PN

0,56

ROPScore 10,7

Medium Risk for Severe ROPVery Low Risk for Severe ROP

• ROPScore is an excellent index of cumulative risk factors to detect severe ROP.

• ROPScore includes risk factors easy to record by the 1st ophthalmological examination.

• ROPScore is more accurate than BW and GA to predict severe ROP in VLBW.

• ROPScore is independ from the previous established screening criteria.

• The cutoff points could be recalculated for different populations according to the incidence

of severe ROP.

• ROPScore is applied only once by completed the 2nd week of life and before the1st ophthalmological examination.

• ROPScore can decrease the number of ophthalmological examination around 50 or 60 % when

compared with the National Guidelines.

TAKE-HOME MESSAGES

ROPScore is available in a free APP in Google Play or Appstorethanks to Dra. Evangelina Esposito and colleagues of Cordoba

www.sp-rop.com

www.joaoborgesfortesfilho.com.br

Master, Doctor and Post-Doctor in Ophthtalmology

João Borges Fortes Filho

FACULDAD DE MEDICINAUNIVERSIDAD FEDERAL DO RIO GRANDE DO SULHOSPITAL DE CLÍNICAS DE PORTO ALEGRESOCIEDAD PANAMERICANA DE RETINOPATÍA DEL PREMATURO

Muchas gracias !Thank you !