PURPOSE: To assess the rate of retinal vascularization derived from ultra-widefield (UWF) imaging-based retinopathy of prematurity (ROP) screening as predictor of type 1 ROP and characterize the effect of anti–vascular endothelial growth factor (anti-VEGF) therapy on vascularization rate. •DESIGN: Retrospective, consecutive cohort study. •SUBJECTS: The study included 132 eyes of 76 premature infants with a mean gestational age (GA) of 26.0 ( ±2.0 SD) weeks and birthweight (BW) of 815 ( ±264) g, who underwent longitudinal UWF imaging for ROP screening, at a level 3 neonatal unit in Oxford, United Kingdom. •METHODS: The extent of retinal vascularization on each UWF image was measured as the ratio between “disc-to-temporal vascular front”and “disc-to-fovea”distance along a straight line bisecting the vascular arcades. Measurements from ≥3 time points plotted against post- menstrual age (PMA) enabled calculation of temporal vascularization rate (TVR) for each eye. Using TVR, GA, and BW as predictors, a machine learning model was created to classify eyes as either group AB (no ROP and type 2 ROP) or group C (type 1 ROP). The model was validated in a withheld cohort of 32 eyes (19 infants), of which 8 eyes (5 infants) required treatment. TVR in 37 eyes (20 infants) was compared before and after ultra- low-dose (0.16 mg) intravitreal bevacizumab treatment.
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