Retinopathy of Prematurity in Vietnam: A Silent Burden and a Call for Action

In Vietnam, over 1.4 million children are born each year, of whom approximately 10% are preterm. For those tiny infants lying in incubators, their fragile eyes face a silent killer named 'retinopathy of prematurity' (ROP). For every 10 preterm infants, 1 to 3 may develop the disease, yet without timely screening and treatment, they will live in permanent darkness. Alarming, Vietnam still has no mandatory national screening program for this high-risk group.

Let us analyze the current situation, causes, and barriers that are turning ROP into an invisible health burden, while also proposing feasible solutions to save the eyesight of thousands of children each year.

A painful reality in neonatal wards

In a preliminary study at Children's Hospital 1, one of the country's largest neonatal centers, the rate of ROP among sick preterm infants may reach 30%. At the Central Eye Hospital, the number of children presenting with ROP has steadily increased, but most arrive late, when intervention is highly difficult.

What worries doctors is not just the numbers but the enormous gap between risk and access to screening. While major cities like Hanoi and Ho Chi Minh City have modern equipment and trained specialists, in many rural provinces, most preterm infants never receive an eye exam after discharge. The consequence is that thousands of children go blind simply due to a missed check-up at the wrong time.

ROP is a proliferative retinal vascular disorder in premature infants, typically appearing within 4–6 weeks after birth. If detected early, treatment with laser or anti-VEGF injection can preserve vision. But if this 'golden window' is missed, the disease progresses rapidly, leading to retinal detachment and irreversible blindness.

Why is Vietnam facing an 'epidemic' of ROP?

The answer sounds paradoxical: it is precisely due to medical progress in saving preterm infants that the number at risk of ROP has climbed. Where infants born before 28 weeks rarely survived before, modern NICUs can help them pull through the brink of death. However, this survival has brought with it an unresolved consequence:

• Non-standardized oxygen management: Many regional and central hospitals use oxygen therapy in an unscientific way, causing fluctuating blood oxygenation that increases ROP risk. Globally, poor oxygen control is the leading modifiable cause.
• Lack of mandatory recommendations: Although the Ministry of Health has issued guidelines on eye care for preterm infants in some hospitals, there is no regulation making ROP screening mandatory nationwide. Screening depends largely on the attitude of each facility and treating physician.
• Lack of specialized workforce: The entire nation has only a few hundred pediatric retinal specialists, mostly concentrated in two major centers. To screen all preterm infants nationwide would require roughly five times the current workforce.
• Limited awareness of families: Many parents are unaware of their child's risk of blindness, or are not instructed to bring their infants for scheduled eye checks.

The healthcare system is overloaded and fragmented

In the bigger picture, Vietnam is at a primitive stage in building a comprehensive ROP screening system. The coordination between pediatrics, obstetrics, and ophthalmology remains fragmented. A clear referral pathway is needed: every hospital with a neonatal unit should register all eligible preterm infants and refer them to specialized centers within four weeks after birth, as is done in developed nations.

The cost of a laser treatment session ranges from 3 to 5 million VND, excluding travel expenses, which makes many families hesitate and thus miss the treatment window. Without supportive health insurance policies, any appeal will remain theoretical.

The contrarian view: Is this overblown?

Some experts argue that making ROP a mandatory screening program nationwide will overwhelm the already strained system. They point out that not every preterm infant gets ROP, and the majority of mild cases resolve spontaneously. The cost of mass screening is high, while resources should be directed to more urgent health issues like infectious diseases or malnutrition.

However, that argument is contrary to the global evidence. According to the World Health Organization, ROP is one of the preventable causes of childhood blindness in middle-income countries, as premature infant survival improves. Without action, Vietnam could fall into the 'ROP trap' many countries experienced: it is far more costly to care for a blind child over a lifetime than to perform a screening examination.

In fact, a fundoscopic screening costs only about 100,000–200,000 VND per exam, far less than laser treatment or caring for a blind child for decades. The numbers are obvious if we consider long-term economic benefits.

The time to act is now

The ROP picture in Vietnam is not an impending catastrophe but a long-ignored silence. We may be holding the key to saving thousands of children from darkness, but no one has turned it in the lock. Experts recommend:

1. The Ministry of Health should issue a Circular making eye exams mandatory for all preterm infants under 34 weeks or weighing under 1800g, with a roadmap starting in 2026.
2. Establish a screening network at provincial hospitals, equipping them with indirect ophthalmoscopes and training support.
3. Include ROP screening in the health insurance benefit package, reducing the financial burden on families.
4. Enhance community communication, guiding mothers of preterm babies to bring their children for eye exams at discharge.

Vietnam has achieved many successes in controlling preventable blindness, such as cataract and glaucoma, but with ROP, we lag behind countries like Thailand and Malaysia. The time has come for policymakers to see ROP not just as an ophthalmological issue, but as a shared responsibility of the entire healthcare system and society. Children's eyes cannot wait and must not be forgotten.