dear sir

Do you have any experience in this field?

https://doi.org/10.1016/j.ophtha.2025.09.020

I'm working at one of the intervention sites in the study After the inclusion period finished we continued to use it for all affected infants according to the treatment indication of the study, and still do.

Were there any particular questions you had regarding the results and the treatment? I might not be able to answer the ophthalmologic questions myself, but could get back to you with an answer from one of the authors.

I found this study very intriguing, and I have a few questions and observations.

It appears that the majority of babies were screened and diagnosed using the RetCam. Was this consistent both before and after the intervention period? I ask because there is evidence (e.g. Moshfeghi et al.) that the incidence of surgical ROP decreased dramatically after the introduction of telemedicine for ROP.

In addition, there are no on-site contemporary controls, so this is not a randomized study, and the off-site controls may not be fully equivalent. The article specifically states that the same neonatologists were not consistently involved across all centers or throughout the different study periods.

Do you think that the introduction of systemic steroids at the intervention site only, in 2021, during the first 10 postnatal days, is significant in interpreting the results?

The treatment percentage at the intervention center prior to the intervention seems very high (72% progressed from Type 2 to Type 1). This does not match our experience and is very different from the control groups. Even so, the treatment percentage in the intervention group is very impressive. It seems that even if the 72% were adjusted to a more conservative estimate, say 50%, the impact of the intervention would likely remain statistically significant.

Also, the rate of BPD decreased substantially at the intervention site (from 78% to 34%), whereas only a modest decrease was reported at the control sites (from 78% to 65%). Were the steroids responsible for this decrease in BPD? That is a very interesting possibility. Alternatively, were the intervention-site babies overall healthier and therefore more likely both to have less BPD and for their ROP to improve spontaneously?