Gestational age as the primary predictor of retinopathy of prematurity and treatment requirement

PurposeTo evaluate the predictive role of gestational age (GA) in retinopathy of prematurity (ROP) and to examine perinatal factors associated with ROP development and treatment requirement.MethodsThis retrospective cohort study included 445 preterm infants born before 34 weeks of gestation and followed at a tertiary ROP clinic between February 2024 and January 2025. Demographic and clinical data were retrospectively reviewed. Infants were stratified into weekly GA groups. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for ROP development and treatment-requiring ROP. ROC curve analysis was used to evaluate the discriminative performance of GA.ResultsROP developed in 140 infants (31.5%), and 34 infants (7.6%) required treatment. In multivariate logistic regression analysis for ROP development, both lower GA and lower birth weight (BW) remained significant independent predictors (p < 0.05). In contrast, in the multivariate analysis for treatment-requiring ROP, BW lost its statistical significance, while lower GA and lower 1- and 5-min Apgar scores remained independently associated with the need for treatment (p < 0.05). ROC analysis demonstrated good discriminative ability of GA for both any-stage ROP and treatment-requiring ROP, with optimal cut-off values of ≤30 weeks and ≤28 weeks, respectively.ConclusionGestational age is the primary predictor of ROP severity, retaining its predictive value for treatment-requiring disease when birth weight does not. The additional contribution of Apgar scores highlights the role of early postnatal instability in severe ROP. GA-based thresholds may support more precise and efficient ROP screening strategies.