Preferred practice guidelines for retinopathy of prematurity screening during the COVID-19 pandemic

Table 1 Mandatory questions that were required at the start of the pandemic in 2020

No.	Before screening, as the following 4 questions: (as per Govt guidelines in 2020)
1	International travel in last 4 wk
2	In quarantine period? (See stamp on hand or arm)
3	In isolation as some in family was COVID-19 positive or had contact with COVID positive patient
4	Fever, cough, cold

If yes to any of these 4, the parent/guardian must not enter the hospital and screening will not be performed. These are applicable to the physician, care giver, screening team and hospital staff as well fever is also checked at entry point with a non-contact thermometer (false negative if anti pyretic is taken).

Table 2 Suggested follow-up schedule for retinopathy of prematurity during the coronavirus disease 2019 pandemic

Finding in either eye with respect to zone	Next follow up	Comment
Immature retina in zone 3 and zone 2 anterior	3-4 wk or more	If the PMA is less than 34 wk/< 1500 grams/sick and admitted infant, consider a closer follow-up
Zone 3 and Zone 2 anterior disease	3-4 wk	Spontaneously regressing ROP can be watched
Zone 2 Posterior disease	2 wk	Unless associated with treatment requiring features (see below)
Zone 1 disease	1 wk or treat	Have a low threshold for treatment
Pre-plus	Consider early treatment or early follow-up if pupil does not dilate well and media is not clear	Individualize for each case based on the tempo of disease and PMA
Pre-plus	With good pupillary dilatation and clear media and other low risk features	Can delay the next screening by an additional 1 wk from the current guidelines

PMA: Post menstrual age; ROP: Retinopathy of prematurity.

Table 3 Suggested treatment guidelines for retinopathy of prematurity during the coronavirus disease 2019 pandemic

Disease	Comment
Type 1 ROP (ETROP)[9]	Treat as soon as you possible, preferably on the day that screening was done. Laser recommended
AROP[10]	Treat as soon as possible. Laser if disease is amenable. Intravitreal injections can be used, but caution to be exercised since follow-up may be a critical issue with travel restrictions for the family
Less than Type 1 ROP. Stage 2 with pre plus, stage 3 with no or early plus, high risk for APROP (but not yet full fledged), borderline Zone 1 disease/poor pupil dilatation, unclear media with pre-plus	Given the difficulty to closely follow-up consider treatment a ‘little earlier’ than classical Type 1 ROP
Stage 4A and 4B ROP[10]	Surgery must be performed as soon as treating ROP specialist feels it is required with adequate precautions taken while providing anesthesia
Stage 5 ROP[10]	Surgery is not urgent. Case-to-case based decision must be considered

ROP: Retinopathy of prematurity; AROP: Aggressive retinopathy of prematurity.