Retinopathy of prematurity ! a bulgarian perspective of a global epidemic

Retinopathy of Prematurity ( ROP) is in the focus of public health interest as far as it is one of the most common potentially avoidable causes of visual loss in childhood and can lead to vision impairment and blindness. Therefore, it has lifelong implications for the affected children, their families, but also for the whole society. In Bulgaria, the processes of continuous health care transformations have led to lower quality control over ROP- screening processes. The aim of the presented study is to make a horizon scanning research, which includes: 1) introduction of some ROP-related definitions; 2) a clinical and public health overview of ROP from an international and Bulgarian perspective; 3) presentation of the organizational structure of screening, the early diagnosis and therapy of ROP in Bulgaria. The  methods  used are: meta-analysis of global and national data on ROP; sociological method - questionnaire distributed amongst the ophthalmologists who diagnose and treat ROP and participatory research method e.g. follow up of the patients’ path and the clinical and public health procedures. Globally, the three waves of the ROP-epidemic are described. Nationally, the Bulgarian ROP-related picture is drawn, summarizing and analyzing the results from the interviews with ophthalmologists engaged with ROP-screening from all 28 administrative regions of Bulgaria (Period: April-September, 2015). Finally, after an extensive drill-down of the Bulgarian context and the global developments, locally relevant health policy strategies are proposed like development of a National Consensus on ROP and Registry database of ROP in Bulgaria. Further, a three-level ROP-screening procedure is outlined and the telemedicine application grounded.