Accuracy of the postnatal growth and retinopathy of prematurity screening criteria in predicting prethreshold retinopathy of prematurity in the tertiary hospital, Bangkok, Thailand

Dear Editor, It is worthy to comment on the interesting article by Bunyavee and Hemarat[1] published in the October 2023–December 2023 issue of the TaiwanJournalofOphthalmology. On using the International Classification of Retinopathy of Prematurity (ICROP)[2] and the Early Treatment of Retinopathy of Prematurity (ETROP) study,[3] Bunyavee and Hemarat[1] assessed the sensitivity of postnatal growth and retinopathy of prematurity (G-ROP), retinopathy of prematurity (ROP) predictive model which was constructed in North America, on Thai premature babies. They found that the G-ROP model exhibited high sensitivity and decreased the number of infants receiving unnecessary ROP screening. Bunyavee and Hemarat[1] mentioned the study limitations of the limited number of subjects and the retrospective nature of the work. Hereby, we present a relevant limitation. The ICROP and ETROP classifications utilized in the study are old having been introduced approximately two decades ago.[2,3] The ICROP's third version, ICROP3, has been released to address the following issues: progress in ophthalmic imaging tools and concerns in regard to the subjectivity in essential parameters of ROP classification; innovations in pharmacological medicines, for example, antivascular endothelial growth factor that have a greater rate of regression and reactivation processes posttherapy in comparison with ablative treatments; and finally, the notion that ROP patterns in some areas of the world do not completely fulfill into the current classification system.[4] The ICROP3 kept the current definitions such as stage (view of the disease at a vascular–avascular junction), zone (site of disease), and the circumferential extent of disease. The following are a few of the ICROP3 updates: fundamental classification elements such as notch, posterior Zone II, Stage V subcategorization, and the notion that a continuing shadow of the vascular abnormalities presents ranging from normal to plus disease; and what's more, the use of "aggressive ROP" instead of "aggressive posterior ROP" due to growing notice that aggressive disease might take place in bigger preterm neonates and beyond the posterior retina, especially in resources-constrained areas. These innovations in ICROP3 classification are envisaged to build the standard and quality of ROP care universally and speed up clinical care and research.[4] As a result, this methodological limitation could further put under question the study results stated by Bunyavee and Hemarat.[1] We believe that conducting a study and referring to the new ICROP3 classification[4] in the study methodology could lead to more validated findings. Data availability statement Data sharing not applicable to this article as no datasets were generated or analyzed during the current study. Financial support and sponsorship Nil. Conflicts of interest The author declares that there are no conflicts of interest in this paper.