Retinopathy of prematurity screening in Latin America: A narrative review of barriers, implementation gaps, and emerging solutions

Background

Retinopathy of prematurity (ROP) is a leading preventable cause of childhood blindness. Because severe ROP can progress rapidly, infants at risk need repeated eye examinations during a narrow window in which treatment can preserve vision. In Latin America, improved survival of preterm infants has increased the need for reliable screening, yet access remains uneven. This review examines barriers to ROP screening and strategies that may improve timely access across the region.

Methods

A focused narrative review of PubMed-indexed literature published from 2015 through September 2026 was conducted. Search terms included “retinopathy of prematurity,” “screening,” “Latin America,” “barriers,” “telemedicine,” and “artificial intelligence.” Studies addressing screening coverage, adherence to national criteria, specialist availability, imaging capacity, follow-up, geographic access, policy implementation, and technology-supported screening were prioritized. Evidence from Mexico, Brazil, Argentina, and multicountry regional studies was synthesized.

Results / Findings

Across studies, the main problem was not the absence of screening recommendations but inconsistent implementation. In 32 neonatal intensive care units across five Mexican states, only 31.2% had fully compliant ROP programs; 34.4% had no program and 34.4% had noncompliant programs. Reported limitations included irregular screening, limited ophthalmologist availability, equipment constraints, transfers for examination or treatment, and costs to families. In Brazil, 86% of 78 ophthalmologists involved in ROP care reported following national screening criteria, but retinal imaging was available to only 16.9%, and post-discharge follow-up was inconsistent. A 2026 analysis of 333 respondents from 17 Latin American countries also found substantial variation in adherence to national screening thresholds. Argentina showed that coordinated national action can improve access: participating services expanded from 14 to 98 and screening exceeded 90%. A 2025 study in Mexico and Argentina tested a lower-cost approach using smartphone-recorded retinal videos and machine learning to identify possible ROP, achieving 93.3% patient-level sensitivity, although specificity and accuracy were lower than ophthalmologist assessment.

Discussion & Conclusion

The evidence suggests that preventable vision loss from ROP in Latin America is driven largely by gaps between national recommendations and their implementation in clinical practice. Shortages of trained specialists, limited imaging capacity, geographic barriers, weak follow-up, and program organization can interrupt screening before infants receive complete evaluation. National coordination, reliable referral and follow-up pathways, workforce development, telemedicine, and lower-cost imaging may improve access. Artificial intelligence may extend screening capacity in resource-limited settings but should support, not replace, specialist evaluation. Interpretation is limited by heterogeneous study designs and uneven representation across countries.