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Ocular disease profile in neonates presenting to a tertiary care center

Year: 2025
Type: article
Study design: Observational Study
Abstract: Dear Editor, The spectrum of neonatal ocular diseases is frequently overshadowed by the significant burden of retinopathy of prematurity (ROP) on the healthcare system. While ROP is undoubtedly a critical cause of neonatal blindness, the exclusive focus on it within existing screening programs often results in overlooking other sight-threatening neonatal pathologies. Neonates, particularly those requiring multidisciplinary care, are at risk of a range of anterior and posterior segment abnormalities that demand early detection and prompt management. The lack of universal eye screening for newborns poses a significant barrier to identifying these conditions in a timely manner. In our retrospective study of 749 neonates (1,498 eyes) brought to the ophthalmology outpatient department over 5 years, 44.6% of eyes exhibited abnormalities [Table 1]. This cohort did not include neonates for whom ROP screening was performed. While ROP-related findings were present in 490 eyes, our data showed that 191 eyes had anterior segment abnormalities, whereas 106 (7%) eyes had nonROP-related posterior segment abnormalities. This was 4.5% and 11.5%, respectively, in studies done by Ranjan et al.[1] and Dabir S et al.[2] It is comparable to previous studies, even though we did not include exclusively preterm neonates. Out of 297, 211 required timely intervention, of which 127 eyes had nonROP-related sight-threatening conditions requiring prompt intervention. These included corneal opacity (2.5%), congenital glaucoma (1.9%), congenital cataract (1.8%), retinal detachment (0.8%), and retinoblastoma (0.3%), to name a few [Table 2]. The profile of these conditions underscores the limitations of ROP-focused screening, as many of these pathologies fall outside the purview of current national guidelines.Table 1: Baseline characteristics of the study cohortTable 2: Incidence of neonatal ocular pathologiesThe implications of missing nonROP-related ocular diseases are profound. Neonatal blindness resulting from these conditions can lead to lifelong visual impairment, contributing to developmental delays in motor, psychological, and cognitive growth, as well as socioeconomic challenges.[3] Screening programs designed exclusively for ROP often target specific high-risk populations, such as preterm and low-birth-weight infants, inadvertently excluding neonates with congenital or acquired conditions who may not present with specific complaints. Our study further highlights that, while 88.3% of referrals were initiated by neonatologists, only 25% of self-referred cases were brought in due to parental awareness, indicating a critical gap in knowledge and vigilance regarding other neonatal ocular pathologies. To address these gaps, we propose integrating universal newborn eye screening into existing healthcare frameworks. Such programs should include comprehensive anterior and posterior segment examinations for all neonates before hospital discharge, alongside red reflex testing as a baseline.[4] Increased awareness among parents, neonatologists, pediatricians, and allied healthcare workers about the full spectrum of neonatal ocular diseases is essential. In conclusion, while ROP screening is indispensable, it should not be the sole focus of neonatal ocular health programs. Universal newborn eye screening can mitigate the burden of childhood blindness by enabling the timely identification and management of nonROP-related conditions. This approach will significantly improve the quality of life for affected children and reduce the socioeconomic impact of preventable blindness on families and communities. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
DOI: 10.4103/ijo.ijo_35_25
Institution: Sankara Nethralaya
Language: English
Field: Medicine
Open Access status: diamond
OpenAlex ID: W4409765658
FWCI:
Cites: 3
Cited by:
Related to: 10