Screening Schedules: DR Follow-up, ROP in India and Hydroxychloroquine
Last updated: October 2026
Three screening schedules we use every week: diabetic retinopathy follow-up, ROP screening in Indian neonatal units, and hydroxychloroquine toxicity.
1. Diabetic retinopathy: when to see the patient again (ICO 2017)
| Grade | High-resource setting | Low or intermediate-resource setting | Refer to ophthalmologist? |
|---|---|---|---|
| No apparent retinopathy | 1–2 years | 1–2 years | No |
| Mild NPDR (microaneurysms only) | 6–12 months | 1–2 years | No |
| Moderate NPDR | 3–6 months | 6–12 months | Yes |
| Severe NPDR | Under 3 months | Under 3 months | Yes |
| Proliferative DR | Under 1 month | Under 1 month | Yes |
| Non-centre-involved DME | 3 months | 3 months | Yes (in low-resource settings, if laser is available) |
| Centre-involved DME | 1 month | 1 month | Yes |
These intervals assume reasonable diabetes control. Shorten them in pregnancy (examine each trimester), after rapid HbA1c improvement, and around cataract surgery. Remember the 4-2-1 rule for severe NPDR (see DR guide).
2. Retinopathy of prematurity: who and when (India)
| Question | Indian operational guidelines (MoHFW, RBSK) |
|---|---|
| Whom to screen | All babies with birth weight of 2000 g or less, or gestational age of 34 weeks or less. Also babies over 34 weeks with risk factors: cardiorespiratory support, prolonged oxygen, sepsis, blood transfusion, intraventricular haemorrhage, apnoea or poor weight gain. |
| When to do the first screen | By 25–30 days of life. Screen before discharge even if the baby goes home early. Very small or sick babies (for example under 28 weeks or under 1200 g) are often screened earlier, at 2–3 weeks. |
| Follow-up | Depends on zone and stage: weekly or more often for zone I disease, stage 3, or any pre-plus; every 2 weeks for mature-appearing zone II disease; continue until vascularisation is complete or ROP regresses. |
| When to treat | ETROP type 1 ROP: zone I any stage with plus; zone I stage 3 without plus; zone II stage 2 or 3 with plus. A-ROP needs urgent treatment. Treat within 48–72 hours. |
Indian criteria are wider than Western ones (which use about 1500 g or 30–32 weeks) because larger, more mature babies develop severe ROP in Indian units. See ICROP3 update.
3. Hydroxychloroquine retinopathy (AAO 2016 recommendations)
| Item | Recommendation |
|---|---|
| Safe dose | 5 mg/kg real body weight per day or less |
| Baseline | Fundus exam within the first year to exclude maculopathy; add OCT and fields if abnormal |
| Annual screening | From 5 years of use if there are no major risk factors; from the start if there are |
| Major risk factors | Dose over 5 mg/kg/day, kidney disease, tamoxifen use, pre-existing retinal or macular disease |
| Tests | Automated fields (10-2 white, or 24-2 or 30-2 in Asian patients, whose damage is often pericentral) and SD-OCT. Multifocal ERG and fundus autofluorescence are useful adjuncts. |
| If toxicity is found | Stop the drug in discussion with the rheumatologist. Damage can progress for a while after stopping. |
Other drugs worth a baseline check: ethambutol (acuity and colour vision), vigabatrin (fields), long-term pentosan polysulfate (macula), and long-term steroids (IOP and lens). See the ocular adverse drug reactions page.
Key sources
- ICO Guidelines for Diabetic Eye Care (updated 2017)
- Operational guidelines for ROP in India (MoHFW / RBSK)
- Marmor MF et al. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology 2016;123:1386–94
- Early Treatment for Retinopathy of Prematurity Cooperative Group. Arch Ophthalmol 2003;121:1684–94
📘 Want more exam-ready material? See Most Commons in Ophthalmology on Kindle, or browse all my books.
Looking for an eye specialist in Ahmedabad? Read about diabetic retinopathy care at Sadbhaav or book a consultation with Dr. Dhaval Patel.