The following questions are designed to test learners' knowledge of retinopathy of prematurity.  This case was prepared by Calvin Tseng, a medical student at the University of Alberta, with assistance from Dr. Carlos Solarte and Dr. Chris Novak. Dr. Solarte is a pediatric ophthalmologist and Dr. Novak is a pediatric resident, both at the Stollery Children’s Hospital in Edmonton, Alberta, Canada. The recommendations in this case are based on the 2016 Canadian Paediatric Society Practice Point on Retinopathy of Prematurity by Dr. Ann Jefferies.

This case is divided into two parts.  Learning objectives are outlined below:

Part 1: NICU approach to retinopathy of prematurity

Knowledge recall

• Recall screening criterion for ROP
• Recall different ocular physical exam findings in neonates
• List risk factors for ROP
• Recall appropriate screening dates
• Recall first-line treatments for retinopathy of prematurity
• Recall potential complications of retinopathy of prematurity

Comprehension / understanding

• Understand the development of the eye
• Understand the basic pathophysiology of ROP
• Understand that ROP is asymptomatic
• Understand that ROP usually does not have physical signs
• Understand that only a minority of children meeting criterion will have ROP
• Understand of those with ROP, the majority of cases will not require treatment and will resolve spontaneously

Application

• Decide whether a neonate needs retinopathy of prematurity screening
• Decide when ROP screening should occur in a neonate

Part 2: Ophthalmological evaluation and intervention in retinopathy of prematurity

Knowledge recall

• Recall the zones used for ROP screening
• Recall the stages used for ROP screening
• Recall how to determine “extent” of disease
• Recall the features of “Plus Disease”
• Recall the criterion for deciding whether a case is Type 1 (needs treatment) or Type 2 (follow closely)
• Recall the criterion for ROP follow up screening based on initial findings
• Recall the criterion for discontinuing retinal screening

Comprehension / understanding

• Understand the differences between focal laser ablation & anti-VEGF injection, and the relative advantages of each

Application

• Apply the criterion for deciding between Type 1 and Type 2 disease to a case