Importance of the 'third criterion' for retinopathy of prematurity screening in developing countries.

Purpose: Developing countries often need a modification of the American screening guidelines for retinopathy of prematurity.

Methods: A total of 1,302 eyes in 651 infants with retinopathy of prematurity were analyzed by the parameters of gestational age and birth weight suggested by the American guidelines.

Results: With the use of current gestational age and birth weight guidelines, 86 of 1,302 eyes (6.6%) were missed, and 38 of these eyes (2.9%) had potentially treatable or more severe retinopathy of prematurity and were in need of treatment.

Conclusion: Use of the "third criterion" (ie, neonatologist referral of sick infants who were believed to be at high risk for retinopathy of prematurity), enabled larger infants who were otherwise missed by the American guidelines to be included for screening. Even when the parameters were increased, a relatively small number of infants was still missed. Therefore, in view of the limited resources and manpower in developing countries, the American screening guidelines are appropriate.