Risk Management

2019 February Announcement: ROP Safety Net Revised

February 2019 Risk Management Announcement

ROP Safety Net and Underwriting Requirements Revised

Dear Colleague:

The American Academy of Pediatrics Section on Ophthalmology revised its Policy Statement (PS)¹ on ROP screening late last year. We revised the clinical tables in our ROP Safety Net accordingly.

POLICY STATEMENT CHANGES

The key changes relate to follow-up and when to conclude ROP screening exams. They are shown in yellow.

• Postmenstrual age (PMA) of 45 weeks: No type 1 ROP or worse, no anti-VEGF medications
  • This used to be 50 weeks.
• Postmenstrual age of 65 weeks: Infants treated with anti-VEGF
  • This is a new recommendation.
  • Follow closely until at least 65 weeks PMA.
  • Particularly close follow-up is needed during the time of highest risk for disease reactivation (45 to 55 weeks PMA).
  • Full retinal vascularization is the only criterion that can be relied upon as a valid conclusion point in infants treated solely with anti-VEGF.
    • Not all infants treated with anti-VEGF achieve full retinal vascularization.
    • Ophthalmologists should rely upon prolonged observation, clinical judgment, and evolving criteria for termination of exams or need for further treatment if infants do not achieve full retinal vascularization.

CHANGES TO CONDITIONS OF COVERAGE FOR ROP

We revised the ophthalmologist’s obligations for follow-up when an infant is treated with anti-VEGF medication so that they are consistent with the new PS. Changes are in yellow.

• Follow infants closely until at least 65 weeks postmenstrual age (PMA)
  • PLEASE NOTE: Weekly exams are no longer required. Instead, we have adopted the PS recommendation to follow these infants “closely” until at least 65 weeks PMA.
• At 65 weeks PMA, may end screening if either of these endpoints has been reached:
  • Full vascularization in close proximity to the ora serrata for 360° OR
  • The avascular retina has been successfully treated with laser (e.g., no skip areas).
• Use professional judgment on continued monitoring in the following circumstances if no treatment endpoint has been reached at 65 weeks PMA:
  • Low-grade disease that is clearly and slowly improving
  • Stage 1 disease that is unchanged for 2 months
  • No disease, no ROP, but incomplete vascularization
  • Infant has a DNR order

You may access the revised clinical tables and the entire ROP Safety Net at http://www.omic.com/rop-safety-net/. Remember that you may contact the Risk Management Hotline for confidential assistance by emailing us at riskmanagement@omic.com or calling 800-562-6642, option 4.

Sincerely,

Robert S. Gold, MD
Chair of the OMIC ROP Task Force

¹ Fierson WM. “Screening Examination of Premature Infants for Retinopathy of Prematurity.” Policy Statement (PS) issued by the American Academy of Pediatrics (AAP) Section on Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and the American Association of Certified Orthoptists. Originally issued in 1997 and updated in 2001, 2005, 2006, and 2018; current version published in Pediatrics (Volume 142, Number 6, 2018, at http://pediatrics.aappublications.org/content/early/2018/11/21/peds.2018-3061.