Retinopathy of Prematurity (ROP) is a leading cause of blindness in premature infants. If recognized and treated early, severe vision loss or total blindness is preventable. Vigilance is required from not only pediatric ophthalmologists but also the neonatologists and neonatal nurses to recognize the warning signs based upon frequent examinations and close monitoring.
Failures in monitoring and providing timely treatment constitutes medical malpractice and can have dire lifetime consequences for the newborn and their families. This month, an international team of ROP experts issued a consensus statement that further develops a standard nomenclature for classification of ROP. The principles may improve the quality and standardization of ROP care worldwide and provide a foundation to improve research and clinical care.
The resulting Third Edition is now required because of challenges such as subjectivity in critical elements of disease classification, innovations in ophthalmic imaging, and recognition that patterns of ROP in some regions of the world do not fit into the current classification system.
Our firm has represented children who have suffered catastrophically and are either totally blind or significantly limited in their vision due to inadequate diagnosis of and treatment for ROP. These children will never cross the street alone and never drive—just to name a few of a long list of impairments that were preventable. These children will never be able to participate in regular school activities and will likely find substantial limitations in career opportunities.
We discovered in our investigation of cases there was a period of time where the care providers involved were taking a “wait and see” approach to treatment. That decision may have been based on probability, but it remains a gamble if a child is part of the group where there is regression or where the findings are borderline. In those cases, the direction on which way to go may be a subjective judgment. That approach to treatment does not meet the standard of care.
Judgments are dependent on a number of factors, including the experience of the care providers. “Wait and watch” is a scary proposition. Treatment in the right hands has very little downside, while blindness in the wrong hands lasts forever.
Overall, this study shows that gaps do exist in the algorithm for decision-making on treatment and suggests the need for a tighter spectrum approach to filling the assessment gaps. Providing a more precise “go” or “no go” decision to the treatment is what is needed.
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