Comment on: Risk factor-based models to predict severe retinopathy of prematurity in preterm Thai infants

Dear Editor, This commentary concerns the article “Risk factor-based models to predict severe retinopathy of prematurity in preterm Thai infants” by Natthapicha Najmuangchan et al. published in the Indian Journal of Ophthalmology.[1] This study offers valuable insights into predictive models for severe retinopathy of prematurity (ROP) in preterm infants. The objective is to reduce the number of unnecessary eye examinations while ensuring the safety of high-risk infants. Nevertheless, while the findings are encouraging, several aspects require further discussion and investigation. This study examined preterm infants who were screened for ROP between the period of September 2009 and December 2020. The lengthy period is a significant limitation, given that changes in medical practices and technology may affect the incidence and severity of ROP. Further improvements could be made by conducting time segmentation analysis and interaction term analysis. The application of these improvements will provide a more comprehensive understanding of the period’s impact on study results, enhancing the reliability and scientific validity of the study. To gain a more comprehensive understanding of the risk factors for ROP and improve the reliability of the study, further analyses of the following confounders are essential: gender differences, multiple pregnancies, socioeconomic factors, and different oxygen therapies.[2,3] These additional analyses will facilitate a more comprehensive understanding of the risk factors for severe ROP, thereby informing the development of more effective clinical practices and preventive measures. The inclusion criteria for this article included preterm infants considered clinically unstable by neonatologists.[4] However, the specific definition and criteria for clinical instability were unclear, which has undoubtedly led to subjectivity and inconsistency in the inclusion criteria. It is, therefore, necessary to clarify the definition and criteria for clinical instability to reduce subjectivity and improve the consistency of the inclusion criteria. ROP represents a significant cause of childhood blindness and is associated with a range of unfavorable neurodevelopmental outcomes. Given the prolonged nature of the disease, it can have a profound impact on both the child and their family. It is of the utmost importance to implement effective tertiary prevention strategies to reduce the impact of ROP on preterm infants. Primary prevention: Improved prenatal care and maternal health management can and will reduce the rate of preterm labor, thereby reducing the risk of ROP. Secondary prevention: Early screening and diagnosis, the use of telemedicine, and the training of healthcare professionals to recognize early signs of ROP and ensure timely referral to an ophthalmologist. Tertiary prevention: Timely treatment, long-term follow-up, and rehabilitation to ensure timely management and support of visual and neurological development of children with residual visual impairment. The present study presents risk factor-based prediction models that effectively reduce the number of unnecessary eye examinations for preterm infants while ensuring the safety of those at high risk for severe ROP. It is recommended that future research focus on the prospective validation of these models to confirm their effectiveness and reliability in larger populations. Financial support and sponsorship: This research received a grant from the Medical Science and Technology Foundation of Guangdong Province; Number: A2023273. Conflicts of interest: There are no conflicts of interest.