Adherence to Pediatric Ophthalmology Follow-Up After Completion of Retinopathy of Prematurity: A Retrospective Review

Abstract

Purpose: Retinopathy of prematurity is a leading cause of preventable childhood vision loss, and infants remain at risk of long-term ocular complications even after ROP screening concludes. However, adherence to recommended pediatric ophthalmology follow-up after ROP screening completion is not well characterized. This study aimed to evaluate adherence to pediatric ophthalmology follow-up visits after completion of ROP screening and identify factors associated with loss to follow-up in a tertiary care setting. Patients and Methods: We performed a retrospective chart review of premature infants eligible for ROP screening at a single urban academic center between January 2018 and December 2021. All infants were screened by a single vitreoretinal specialist, with pediatric ophthalmology follow-up recommended at the time of ROP clearance within 4 to 6 months. The primary outcome was a documented follow-up visit with pediatric ophthalmology. Demographic, perinatal, and ROP-related factors were compared between those who did and did not follow up, using univariate and multivariate logistic regression analyses. Results: Of 475 eligible infants, 223 (46.9%) completed at least one pediatric ophthalmology follow-up appointment. In multivariate analysis, outpatient discharge from ROP care (OR 0.66, 95% CI 0.45–0.97, p = 0.035) and higher gestational age (OR 0.92, 95% CI 0.84–1.00, p = 0.041) were significantly associated with lower adherence to follow-up. Timing of follow-up (pre-COVID-19 vs COVID-19 era), insurance status, race, ethnicity, number of comorbidities, and distance to the clinic were not significantly associated with follow-up adherence. Conclusion: Fewer than half of infants completed their recommended pediatric ophthalmology follow-up appointments after ROP screening completion. Lower adherence among infants discharged from outpatient ROP care and those born at higher gestational ages highlights a critical care transition from ROP screening to pediatric ophthalmology. Interventions such as scheduling follow-up appointments prior to discharge and improving caregiver education may enhance continuity of care and reduce preventable vision loss in this vulnerable population.