In Guatemala, a developing country with a low per capita income and a high birth rate, 13%-18% of babies that are born from mothers aged between 15 and 49 years weigh less than 2.5 kg⁽¹⁾. As a consequence, retinopathy of prematurity (ROP) is emerging as an important public health problem^(2-3). ROP is one of the major avoidable causes of childhood blindness worldwide. With the increased survival rate of infants with a very low birth weight, the absolute number of children with visual impairment secondary to ROP has increased⁽⁴⁾. In Latin America, the prevalence of any ROP stage ranges from 6.6% to 82%, and the prevalence of severe ROP that requires treatment varies from 1.2% to 23.8%. Unfortunately, in many countries in Latin America, routine screening for ROP is unavailable, and services for its treatment are lacking⁽⁵⁾.

To highlight the urgency for creating a formal ROP screening program in Guatemala, we reported the characteristics of a group of patients who had terminal stages of ROP but were never screened for it and consequently untreated (missed opportunities). We detected 30 patients and collected their data for 1 year at two ophthalmological reference centers in Guatemala City. All the patients were born in hospitals outside Guatemala City, where no ROP screening program is available.

Table 1 presents the characteristics of these cases. The average age at consultation was 14.38 months (range of 3-60 months), the average birth weight was 1395.36 g (range of 794-1900 g), and the average gestational age was 31.5 weeks (range of 25-36 weeks). In 10 cases, gestational age was unknowne, but mothers indicated that their babies were born between 6 and 8 months of gestation.

In 1 year, many children with ROP became blind, so ROP was probably secondary to a high incidence of severe stages without screening.

Many hospitals located in the capital city are covered by ROP screening programs, but many premature children survive in hospitals outside this area. Hospitals in rural areas face various health system challenges, such as insufficient equipment and qualified personnel for the optimal treatment of premature patients. These hospitals also lack trained ophthalmologists who can detect and treat ROP. Other problems include difficulty in accessibility, poverty, and cultural differences, such as language. For these reasons, ROP in patients is undetected in their place of birth. In this case series, the data suggested that premature children with a wide range of weight and gestational age should be evaluated (unusual cases). The prevalence of blindness will likely increase in the future if necessary short-term measures will not be implemented. The first steps in the development of a formal ROP detection program are already being implemented in the Health Ministry by establishing a national regulation program. However, this program has several limitations, including the lack of equipment and qualified personnel for the execution of the program. Therefore, formal treatment planning must be initiated and prioritized.

REFERENCES

1. Guatemala. Ministerio de Salud Pública y Asistencia Social. Informe final VI Encuesta Nacional de Salud Materno Infantil 2014-2015 (ENSMI). Guatemala: Ministerio de Salud Pública y Asistencia Social. Instituto Nacional de Estadística. Secretaría de Planificación y Programación de la Presidencia; 2017.[cited 2020 Jun 5]. Available from: https://www.ine.gob.gt/images/2017/encuestas/ensmi2014_2015.pdf.

2. Sanchez ME, Andrews BJ, Karr D, Lansingh V, Winthrop KL. The emergence of retinopathy of prematurity in Guatemala. J Pediatr Ophthalmol Strabismus. 2010 May 21;47:e1-4.

3. Zimmermann-Paiz MA, Fang-Sung JW, Porras-Jui DK, Cotto-Menchu EJ, Romero-Escriba AL. Retinopatía del prematuro en un país en vías de desarrollo. Rev Mex Oftalmol. 2009;83:323-6.

4. Gilbert C, Fielder A, Gordillo L, Quinn G, Semiglia R, Visintin P, et al.; International NO-ROP Group. Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: implications for screening programs. Pediatrics. 2005;115(5):e518-25.

5. Carrion JZ, Fortes Filho JB, Tartarella MB, Zin A, Jornada ID Jr. Prevalence of retinopathy of prematurity in Latin America. Clin Ophthalmol. 2011;5:1687-95.