The Early Treatment for Retinopathy of Prematurity Study (ETROP)

NCT ID: NCT00027222

Last Updated: 2005-06-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2/PHASE3

Study Classification

INTERVENTIONAL

Study Start Date

2001-10-31

Brief Summary

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The goal of the Early Treatment for Retinopathy of Prematurity Study (ETROP) is to test the hypothesis that earlier treatment in carefully selected cases will result in an overall better visual outcome than treatment at the conventional CRYO-ROP threshold point in the disease.

Detailed Description

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At age 5 1/2 years, the oldest age for which follow-up data are available, children with threshold ROP who were enrolled in the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) -- Outcome Study showed fewer treated eyes (31.5 percent) than control eyes (48 percent) that were blind (P\<0.001). Of those eyes that had a favorable structural outcome, with or without retinal ablation (cryotherapy to destroy the fringe of the retina through freezing), only a small percentage had best corrected visual acuity better than or equal to 20/40 at age 5 1/2 years (13 percent in the treated group; 17 percent in the untreated control group (P=0.19)). Among the 1398 followed from the 5 large natural history centers of the CRYO-ROP follow-up study, children with retinal residua of ROP (structural changes) had measurable visual acuity that was severly affected and tended to worsen with age. The CRYO-ROP Study proved conclusively that peripheral retinal ablation improves the chances of avoiding blindness, but at least 80 percent of eyes are left with acuity less than 20/40.

Two concerns emerged from the CRYO-ROP extensive study on the natural history of ROP and treatment of threshold ROP. The first of these is failure of peripheral retinal ablation to eliminate all, or nearly all cases, of retinal detachment due to ROP. In the CRYO-ROP Study, 26 percent of eyes with threshold disease in zone II and 78 percent of eyes with zone I threshold disease had an unfavorable structural outcome despite treatment. The second concern is that most children who developed threshold ROP disease had visual acuity worse than 20/40 even if the eye had a favorable structural outcome.

Since no other treatment has yet been shown to be effective in preventing blindness from ROP, retinal ablation remains the treatment of choice. The ETROP Study will test whether earlier treatment is more effective than treatment at threshold in improving functional (visual acuity) outcome following ROP, as well as determining whether earlier treatment decreases the probability of an unfavorable structural outcome.

Earlier treatment is defined as retinal ablation administered to the avascular retina when an eye reaches high risk prethreshold retinopathy of prematurity (ROP). Prethreshold indicates any Zone I ROP; or Zone II stage 2 with plus disease, or stage 3; or Zone II with less than 5 contiguous or 8 cumulative clock hours of stage 3 ROP with plus disease. Recognizing that a substantial number of eyes undergo spontaneous resolution of ROP, eyes will be randomized to early treatment only when high risk for an unfavorable visual acuity outcome is identified. High risk will be determined using a risk model analysis program based on longitudinal natural history data obtained from the CRYO-ROP study. This model integrates risk factors to assign a risk of progression to blindness without treatment. These factors include birth weight, gestational age, ethnicity, singleton/multiple status, outborn status, Zone on first exam, severity of ROP and rate of progression of ROP. When an infant develops prethreshold ROP and greater than or equal to 15 percent risk of unfavorable outcome, randomization to early treatment of one eye will occur. Visual acuity outcome will be measured by masked observers after wearing best correction using the Teller Acuity Card Procedure at 9 months corrected age.

Conditions

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Retinopathy of Prematurity

Study Design

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Primary Study Purpose

TREATMENT

Interventions

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retinal ablation

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

Infants \<1251 grams birthweight born at participating centers and/or examined by 42 days of life are eligible. The early treatment trial requires that an infant have prethreshold retinopathy of prematurity (ROP).
Minimum Eligible Age

0 Years

Maximum Eligible Age

42 Days

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Eye Institute (NEI)

NIH

Sponsor Role lead

Principal Investigators

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William V. Good, M.D.

Role: STUDY_CHAIR

Smith-Kettlewell Eye Research Institute

Locations

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Stanford University School of Medicine

Palo Alto, California, United States

Site Status

Smith-Kettlewell Eye Research Institute

San Francisco, California, United States

Site Status

UIC Eye Center Department of Ophthalmology and Visual Sciences The Lions of Illinois Eye Research Institute

Chicago, Illinois, United States

Site Status

Indiana University Department of Pediatrics

Indianapolis, Indiana, United States

Site Status

University of Louisville Health Sciences Center

Louisville, Kentucky, United States

Site Status

Tulane University Medical Center

New Orleans, Louisiana, United States

Site Status

University of Maryland School of Medicine

Baltimore, Maryland, United States

Site Status

The Zanvyl Krieger Children's Eye Center

Baltimore, Maryland, United States

Site Status

Tufts University School of Medicine Department of Pediatrics

Boston, Massachusetts, United States

Site Status

Pediatric Ophthalmology Associates, PC

Dearborn, Michigan, United States

Site Status

University of Minnesota

Minneapolis, Minnesota, United States

Site Status

Cardinal Glennon Children's Hospital Neonatology Office

St Louis, Missouri, United States

Site Status

The Children's Hospital of Buffalo Department of Ophthalmology

Buffalo, New York, United States

Site Status

Edward S. Harkness Eye Institute

New York, New York, United States

Site Status

University of Rochester Medical Center

Rochester, New York, United States

Site Status

Eastern Long Island Retina Associate

Shirley, New York, United States

Site Status

Duke University Eye Center

Durham, North Carolina, United States

Site Status

Columbus Children's Hospital

Columbus, Ohio, United States

Site Status

The Dean A. McGee Eye Institute

Oklahoma City, Oklahoma, United States

Site Status

Oregon Health Sciences University Casey Eye Institute

Portland, Oregon, United States

Site Status

The Children's Hospital of Philadelphia Division of Pediatric Ophthalmology

Philadelphia, Pennsylvania, United States

Site Status

Magee-Women's Hospital

Pittsburgh, Pennsylvania, United States

Site Status

Medical University of South Carolina

Charleston, South Carolina, United States

Site Status

Baylor College of Medicine Feigin Center

Houston, Texas, United States

Site Status

University of Texas Health Science Center at San Antonio

San Antonio, Texas, United States

Site Status

John Moran Eye Center University of Utah Health Sciences Center

Salt Lake City, Utah, United States

Site Status

Countries

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United States

References

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Wallace DK, Bremer DL, Good WV, Fellows R, Summers CG, Tung B, Hardy RJ. Correlation of recognition visual acuity with posterior retinal structure in advanced retinopathy of prematurity. Arch Ophthalmol. 2012 Dec;130(12):1512-6. doi: 10.1001/archophthalmol.2012.2118.

Reference Type DERIVED
PMID: 22892757 (View on PubMed)

Good WV, Hardy RJ, Wallace DK, Bremer D, Rogers DL, Siatkowski RM, De Becker I, Summers CG, Fellows R, Tung B, Palmer EA. beta-Blocking and racial variation in the severity of retinopathy of prematurity. Arch Ophthalmol. 2012 Jan;130(1):117-8. doi: 10.1001/archopht.130.1.117. No abstract available.

Reference Type DERIVED
PMID: 22232483 (View on PubMed)

VanderVeen DK, Bremer DL, Fellows RR, Hardy RJ, Neely DE, Palmer EA, Rogers DL, Tung B, Good WV; Early Treatment for Retinopathy of Prematurity Cooperative Group. Prevalence and course of strabismus through age 6 years in participants of the Early Treatment for Retinopathy of Prematurity randomized trial. J AAPOS. 2011 Dec;15(6):536-40. doi: 10.1016/j.jaapos.2011.07.017.

Reference Type DERIVED
PMID: 22153396 (View on PubMed)

Early Treatment for Retinopathy of Prematurity Cooperative Group; Dobson V, Quinn GE, Summers CG, Hardy RJ, Tung B, Good WV. Grating visual acuity results in the early treatment for retinopathy of prematurity study. Arch Ophthalmol. 2011 Jul;129(7):840-6. doi: 10.1001/archophthalmol.2011.143.

Reference Type DERIVED
PMID: 21746974 (View on PubMed)

Quinn GE, Dobson V, Hardy RJ, Tung B, Palmer EA, Good WV; Early Treatment for Retinopathy of Prematurity Cooperative Group. Visual field extent at 6 years of age in children who had high-risk prethreshold retinopathy of prematurity. Arch Ophthalmol. 2011 Feb;129(2):127-32. doi: 10.1001/archophthalmol.2010.360.

Reference Type DERIVED
PMID: 21320954 (View on PubMed)

Christiansen SP, Dobson V, Quinn GE, Good WV, Tung B, Hardy RJ, Baker JD, Hoffman RO, Reynolds JD, Rychwalski PJ, Shapiro MJ; Early Treatment for Retinopathy of Prematurity Cooperative Group. Progression of type 2 to type 1 retinopathy of prematurity in the Early Treatment for Retinopathy of Prematurity Study. Arch Ophthalmol. 2010 Apr;128(4):461-5. doi: 10.1001/archophthalmol.2010.34.

Reference Type DERIVED
PMID: 20385942 (View on PubMed)

Early Treatment for Retinopathy of Prematurity Cooperative Group; Good WV, Hardy RJ, Dobson V, Palmer EA, Phelps DL, Tung B, Redford M. Final visual acuity results in the early treatment for retinopathy of prematurity study. Arch Ophthalmol. 2010 Jun;128(6):663-71. doi: 10.1001/archophthalmol.2010.72. Epub 2010 Apr 12.

Reference Type DERIVED
PMID: 20385926 (View on PubMed)

Other Identifiers

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NEI-83

Identifier Type: -

Identifier Source: org_study_id