by Rachelle Anzures, MD
The Retinopathy of Prematurity Working Group (ROPWG) under the Philippine Academy of Ophthalmology (PAO) was established in December 2012 to provide a forum for ophthalmologists and neonatologists to share knowledge and experience regarding the current status of retinopathy of prematurity in the Philippines. It was created as an overseeing body specifically tasked to address the ROP problems in the Philippines, including the creation of quality programs to prevent and treat the disease condition.
The main objective of the ROP working group is to decrease the prevalence of visual impairment secondary to ROP in the Philippines. In order to achieve this purpose, the group instituted activities to: 1) to increase awareness of ROP at different levels (ophthalmologists, pediatricians and lay community); 2) to review and modify existing joint statement on ROP screening and treatment; 3) to develop a national registry/database on ROP; 4) to develop a referral network/system for screening and management of ROP and 5) to push for legislation of ROP screening.
The Philippine ROP Screening Guidelines
The first major project of the group was launched on November 17, 2013. The PAO- ROPWG, together with the Philippine Society of Pediatric Ophthalmology and Strabismus (PSPOS) and Vitreo-Retina Society of the Philippines (VRSP), has released the Recommended Philippine Guidelines for Screening and Referral of Retinopathy of Prematurity. It is a policy statement that addresses the Filipino babies at risk of developing ROP and mainly contains screening and referral guidelines with short discussion on the management of ROP. It also includes the list of pediatric ophthalmologists and vitreoretina specialists who perform ROP screening in every Philippine region. The following stakeholders witnessed the event and manifested their pledge of commitment: Philippine Pediatric Society, Community Pediatrics Society of the Philippines, Philippine Society of Pediatric Critical Care Medicine, Perinatal Association of the Philippines, Philippine Society of Newborn Medicine, Resources for the Blind Inc., and the Parents Advocate for Visually Impaired.
ROP Education Campaign for Ophthalmologists
Since 2013, ROP Workshops have been consistently offered to general ophthalmologists and residents in the PAO Annual Convention. The aim of these workshops is to promote ROP awareness in order to educate and encourage potential screeners through a review of disease classification, management and proper techniques in screening preterm babies. As of 2016, a total of 163 ophthalmologists have attended this program.
ROP Awareness Booth
An ROP awareness booth was first set up during the 2014 PAO annual convention to disseminate ROP learning materials. In the campaign to further promote ROP understanding, ophthalmologists were given ROP awareness posters for the lay, ROP screening criteria for NICU posters, ROP staging posters, ROP screening quick guide handbooks, ROPWG screening forms, and the ROP screening guidelines. ROP videos such as step-by-step screening instructions, patient/parents testimonials and lay awareness video were continuously shown. The booth proved to be a success hence its continuous presence in the succeeding mid year and annual conventions.
Web Based ROP Training Module
The commitment of the ROPWG to advance ROP education lead the group to partner with world renowned ROP experts, Dr. RV Paul Chan (Illinois Eye and Ear Infirmary, University of Illinois in Chicago) and Dr. Micheal Chiang (Casey Eye Institute, Oregon Health State University) to initiate the Web Based ROP Training Module Program.
Trainees who participated in the ROP tele-education program were provided unique passwords to a website where they could access the learning system. The tele-education program consisted of clinical cases presented in four unique sections: (1) a pre-test, (2) an ROP tutorial, (3) ROP training chapters, and (4) a post-test. Color fundus photographs included in the tutorial were annotated to highlight relevant findings. References to articles on ROP classification criteria and management considerations were provided to the trainees for additional information. Individual slides were developed for different classifications of ROP diagnosis (plus, zone, stage, category, aggressive posterior ROP) and pertinent management considerations (treatment, follow-up time).
A total of 156 residents and 13 general ophthalmologists have participated in the program. The web based training module will again be offered in 2017.
To take a further step in ophthalmologists’ education, the ROPWG will launch the Mentoring Program for ROP Screening in 2017. A skilled mentor will be paired with a mentee/trainee. This program aims to improve the trainees’ ROP screening skills by mentoring, develop the trainees’ confidence to perform ROP screening, establish a network of ROP screeners in the Philippines and eventually, to increase the number of competent ROP screeners in the country.
In order to attain this, a scientific session entitled “ROP Mentorship 101: a Basic Course for the ROP Trainer” was held last November 24, 2016 during the PAO Annual Convention. The course introduced the pediatric ophthalmologists and retina specialist on how to effectively share their skills and knowledge with trainees in a mentoring program. Forty-four subspecialists all over the Philippines have signed up to be mentors in the program.
On the other hand, 14 general ophthalmologists, who are mostly from the provinces, have volunteered to be trained in the said program.
ROP Awareness Campaign for Pediatricians
The participation of pediatricians, neonatologists and NICU nurses, cannot be overemphasized in the campaign for ROP blindness elimination. For this reason, the 1st Philippine ROP Symposium was organized in November 2014. This featured the lectures of Dr. RV Paul Chan, an international pediatric retina specialist; Dr. Rita Sitorus, a pediatric ophthalmologist from Indonesia; Dr. Risma Kaban, a neonatologist from Indonesia; and Ms. Siti Maryani, a NICU nurse. The occasion was well attended by 150 pediatricians and NICU nurses.
ROP Awareness Campaign for Lay Community
The annual celebration of World Prematurity Day every November 17 is commemorated by lay forums. All ophthalmology residency training institutions are encouraged to conduct lectures and lay education campaign programs on this day to propagate consciousness about this eye disease.
Apl of My Eye Project
The International Campaign for Filipino Children Project by the Apl D’Ap Foundation International in cooperation with the Philippine Academy of Ophthalmology and ROPWG has made possible the availability of a RetCam in Southern Philippines Medical Center in Davao last October 2015. The event is one of the biggest projects of PAO and the ROPWG. This endeavor intends to facilitate residents’ training in ROP screening in the Mindanao region using the RetCam.
One of the upcoming plans of the ROPWG is to set up a resource website where doctors and parents can have access to the various education materials. This website will also contain a database of ophthalmologists who screen and treat ROP in the county . This will also serve as a medium for them to be able to send queries regarding ROP.
A multicenter, prospective clinical trial is also currently ongoing to supplement the current Philippine screening guidelines.
The ROPWG is capably headed by Dr. Pearl Tamesis-Villalon as chair and Dr. Jose Melvin Jimenez, IV as vice-chair. Members are Dr. Rachelle Anzures, Dr. Jubaida Aquino, Dr. Maria Cecilia Arenal, Dr. Milagros Arroyo, Dr. Rena Ivy Bascuna, Dr. Joanne Bolinao, Dr. Carlos Emmanoel Chua, Dr. Kristine Corpus, Dr. Fay Charmaine Cruz, Dr. Marie Joan Loy, Dr. Emilio Macias, Dr. Andrea Pajarillo, Dr. Junn Pajarillo, Dr. Maria Victoria Rondaris, Dr. Darby Santiago, Dr. Alvina Pauline Santiago and Dr. Ricardo Ventura.
True to its name, the ROPWG is faithfully working hard to make a difference and save the Filipino children from a lifetime of blindness.
PAO ROP Workshop
PAO ROP Booth
WEB BASED ROP TUTORIAL MODULE
DR. RV PAUL CHAN @ The First ROP Symposium
DR. RITA SITORUS @ The First ROP Symposium
OSPITAL NG MAKATI ROP LAY FORUM
EAMC DOH Eye Center ROP Exhibit
ST.LUKES ROP LAY FORUM
SILIP BULILIT PROJECT with Apl D Ap Foundation
About The Author
Dr. Rachelle Anzures is a graduate of the Ophthalmology Residency Training Program of Ospital ng Makati and currently serving as a consultant staff in the Medical And Surgical Retina service.
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