Retinopathy of prematurity: preferred practice patterns among pediatric ophthalmologists

Figures & data

Table

1) Do you yourself treat the ROP patient (with laser or injection) following your diagnosis?

a. Yes

b. No

2) Who performs the ROP treatments (laser or injection) at your institution?

a. Yourself

b. Retina specialists

c. Refer/transfer care to different institution

d. Other

3) Do you use Ocular Imaging System (ie, RetCam) to obtain images to assist with the management of ROP?

a. Yes

b. No

4) With what therapy would you begin treatment for ROP with type 1 disease?

a. Confluent laser

b. Avastin injection (skip to question 8 if selecting this choice)

c. Other anti-VEGF medication

d. Cryotherapy

e. No treatment and observe

f. Other

5) If using laser as first-line therapy, what is your rationale for using this modality initially?

a. Personal preference

b. Avastin is not available

c. Avastin is not supported by my institution

d. Unknown safety profile of Avastin

e. Avastin not FDA approved

f. Other

g. N/A

6) If you were to use laser, what location would you perform the laser treatment?

a. NICU

b. Operation room

c. Other

7) How successful do you perceive 1 laser treatment is for most type 1 patients?

a. 10% effective

b. 25% effective

c. 50% effective

d. 75% effective

e. 100% effective

f. Other

8) What is your follow-up protocol after first treatment with the laser?

a. Every week for 4 weeks

b. Every other week for 4 weeks

c. Other

9) If laser has failed after 1 session, what is your next plan of treatment?

a. Laser treatment

b. Avastin injection

c. Other anti-VEGF medication

d. Refer to another colleague

e. Other

10) If using Avastin for treatment (first line or second line), what dose would you use?

a. 1.25 mg/0.05 mL

b. 0.625 mg/0.05 mL

c. 0.375 mg/0.03 mL

d. Other

11) How successful do you feel 1 injection of Avastin is for most type 1 patients?

a. 10% effective

b. 25% effective

c. 50% effective

d. 75% effective

e. 100% effective

f. Other

12) After initial Avastin injection, how soon do you follow-up with the patient to check for regression?

a. 1 day

b. 2 days

c. 3 days

d. 4 days

e. 1 week

f. Other

13) What is your standard time frame for monitoring patients after the initial follow-up visit?

a. Weekly for 1–2 months

b. Weekly for 3–4 months

c. Other

14) If you note a failed initial treatment with a patient after Avastin, what mode of treatment would you consider next?

a. Second Avastin injection

b. Laser

c. Other

15) How long do you wait to see improvement in the ROP prior to next treatment?

a. 5 days

b. 7 days

c. 10 days

d. 14 days

e. Other

16) How many times would you be comfortable reinjecting Avastin after the initial injection?

a. 1 time

b. 2 times

c. 3 times

d. Other

17) Have you noted any complications that may or may not correlate to the developing infant after Avastin injection?

a. Endophthalmitis

b. Systemic hypertension

c. Strokes

d. Pulmonary underdevelopment

e. Other

18) What is your postop antibiotics regimen following Avastin injections?

a. Antibiotic eye drops for 3 days

b. Topical betadine immediately after procedure followed by antibiotic drops

c. Topical betadine immediately after procedure (with no antibiotic drops)

d. No postop antibiotic care

e. Other

Table 1 Physician rationale for using a laser as the first treatment versus injection of IVB

Reasons	N (%)
Personal preference	22 (30.5)
Avastin not available	3 (4.17)
Not supported by institution	7 (9.72)
Unknown safety profile of IVB	39 (54.16)
Not FDA approved	3 (4.17)
Location (zone) of the disease	7 (9.72)
Following national guidelines	2 (2.78)
Frequent follow-up required with Avastin injection	2 (2.78)
Parent refusal for Avastin	1 (1.38)

Note: Physicians were able to choose more than 1 answer.

Abbreviations: FDA, US Food and Drug Administation; IVB, intravitreal bevacizumab.

Table 2 Dosage of bevacizumab used for treatment of ROP

Dosage	N (%)
0.25 mg/0.01 mL	3 (4.16)
0.3125 mg/0.0125 mL	2 (2.77)
0.375 mg/0.03 mL	7 (9.72)
0.5 mg/0.02 mL	1 (1.38)
0.625 mg/0.025 mL	4 (5.55)
0.625 mg/0.05 mL	38 (52.78)
0.75 mg/0.03 mL	2 (2.77)
1.25 mg/0.05 mL	3 (4.17)

Abbreviations: IVB, intravitreal bevacizumab; ROP, retinopathy of prematurity.

Figure 1 First follow-up appointment after injection.

Table 3 Complications following IVB injection

Complications	N (%)
None	67 (66.3)
Systemic hypertension	0 (0)
Stroke	0 (0)
Pulmonary underdevelopment	1 (1.0)
Endophthalmitis	0 (0)
Vitreous hemorrhage	1 (1.0)
Myopia	1 (1.0)
Prolonged time for retinal maturity	1 (1.0)
Developmental delay	3 (2.9)
Demise/death	2 (2.0)
Other, not specified	27 (26.7)

Abbreviation: IVB, intravitreal bevacizumab.