Retinopathy of prematurity care in Colombia: workforce distribution, geographic accessibility, and emerging practice patterns

Abstract Background Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness, and timely screening and treatment are essential for preserving vision. Because ROP care depends on repeated surveillance, referral coordination, and access to specialized ophthalmic services, geographic and workforce constraints may substantially influence outcomes. However, the national organization, accessibility, and service capacity of ROP care in Colombia have not been systematically evaluated. This study assessed the distribution, scope of services, accessibility, and emerging practice patterns within Colombia’s ROP care system. Methods This cross-sectional geospatial health services study linked a clinically validated national registry of pediatric ophthalmologists and retina specialists providing ROP care with population and travel-time datasets. Provider characteristics, service capabilities, delivery models, and population-weighted accessibility to screening and treatment services were evaluated using a nationwide least-cost path model. Results As of September 2025, 54 ROP providers were identified, including 29 pediatric ophthalmologists (53.70%) and 25 retina specialists (46.30%), who are practicing across 51 of Colombia’s 1,103 municipalities (4.62%). Provider distribution was highly urban, with 93.10% of pediatric ophthalmologists and 100.00% of retina specialists located in urban municipalities. Most providers offered both screening and treatment services (82.76% of the pediatric ophthalmologists and 80.00% of the retina specialists). Laser photocoagulation and intravitreal anti–vascular endothelial growth factor therapy were available through 87.04% and 81.48% of providers, respectively, whereas 25.93% reported capability in vitrectomy, all of whom were retina specialists. Telemedicine or hybrid care models were used by 22.22% of the providers. Accessibility analyses revealed substantial screening inequities: 41.60% of the population lived more than 120 minutes from pediatric ophthalmologists, and 46.30% lived more than 120 minutes from retina specialists. Seven providers (12.96%) reported routinely using topical ketorolac or nepafenac off-label for early-stage disease. Conclusions Colombia’s ROP care system relies on a small, urban-concentrated workforce and faces substantial barriers to screening accessibility. The emergence of off-label prophylactic practices warrants prospective clinical and economic evaluation.