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

Every year, thousands of babies are born prematurely, their eyes still developing in a fragile state. For these infants, a condition called retinopathy of prematurity can threaten their sight. It is a disease where abnormal blood vessels grow in the back of the eye, potentially leading to blindness if not caught and treated early. The window to save a child's vision is narrow and unforgiving. Doctors must examine these babies repeatedly over several weeks, looking for signs of trouble. If they see the right warning signs, they can apply a laser treatment or an injection to stop the vessels from growing, usually within a few days of diagnosis. But this life-saving care relies on a perfect chain of events: a baby must be identified as at-risk, examined on schedule, and if necessary, transported quickly to a specialist who can perform the procedure. If any link in this chain breaks, the opportunity to prevent blindness is lost.

In Colombia, a country with vast mountains, dense jungles, and sprawling cities, researchers recently asked a difficult question: can the country's medical system actually deliver this care to all the babies who need it? They did not just count how many doctors there were; they mapped where those doctors live and calculated how long it would take a family to reach them by road. They found that while the country has the medical tools to treat the disease, the journey to get there is often too long for too many families. The study reveals that the system is heavily concentrated in cities, leaving nearly half the population living more than two hours away from the specialists who can screen these babies for the first time.

The researchers built a detailed picture of the medical workforce by verifying the locations and capabilities of 54 specialists who treat this condition. These doctors fall into two groups: pediatric ophthalmologists, who focus on children's eyes, and retina specialists, who focus on the back of the eye. As of late 2025, these 54 doctors were spread across 51 different towns in a country with over 1,100 towns. The distribution was strikingly uneven. Almost all the retina specialists, and more than 90 percent of the pediatric ophthalmologists, practiced in urban areas. Only two pediatric ophthalmologists worked in rural municipalities. This means that for the vast majority of the country, the nearest expert is not just a drive away, but a journey that could take hours.

When the team modeled the travel time for families living across the nation, the results showed a deep divide. For screening, which requires repeated visits over weeks, 41.6 percent of the population lives more than 120 minutes away from a pediatric ophthalmologist. For the retina specialists, who are often needed for the actual treatment, that number rises to 46.3 percent. In other words, nearly half of all Colombians live in areas where getting to a screening appointment is a major logistical challenge. The situation is even more severe in remote regions like the Pacific coast, the Orinoquía plains, and the Amazon, where large portions of the population are effectively cut off from the road network entirely. These families are not just far away; in the model, they are unreachable by ground transport.

Despite these geographic hurdles, the study found that the medical capacity to treat the disease is surprisingly robust once a patient arrives. About 97 percent of the population lives within 48 hours of a facility capable of performing the laser or injection treatments. This suggests that if a baby could somehow get to a major city, the doctors and equipment needed to save their sight are there. However, the researchers caution that this statistic masks a critical problem. Treatment is usually a one-time event, but screening requires a series of visits. The burden of travel accumulates with every appointment. A family that can manage a single trip for treatment may not be able to make the repeated trips required for screening. If a baby misses a screening because the journey is too long, the disease can progress to a point where treatment is no longer possible.

The study also uncovered a new, unofficial way some doctors are trying to cope with these barriers. Because they know that families in remote areas often miss follow-up visits, a small group of providers has started using eye drops containing nonsteroidal anti-inflammatory drugs, specifically ketorolac and nepafenac, for babies with early signs of the disease. These drugs are not officially approved for this use in newborns, but doctors are using them in the hope that they might slow down the disease while the baby waits for a chance to be seen again. The doctors cited the low cost and availability of these drops as reasons for their use, but the researchers emphasized that this is a sign of a system under stress, not a proven solution. It is a desperate attempt to bridge the gap created by distance, and it highlights the need for better ways to monitor these babies without requiring them to travel so far.

To address these challenges, the authors suggest that the focus must shift from simply counting doctors to improving the flow of care. They point to technology as a potential bridge. Telemedicine, where local doctors take photos of a baby's retina and send them to a specialist for review, could reduce the need for travel. Artificial intelligence could help sort through these images to find the most urgent cases. However, the researchers stress that technology alone is not a magic fix. It requires reliable internet, trained staff, and a system that ensures the baby gets the treatment if the photos show a problem. The most effective path forward involves creating regional networks where specialists rotate through different towns, ensuring that screening happens close to home and that the referral to treatment is seamless.

The ultimate lesson from this work is that saving a child's sight depends on more than just having the right medicine. It depends on the reliability of the journey. In Colombia, the medical tools exist, but the geography and the organization of care create a barrier that threatens to leave too many children behind. The study does not claim to have solved the problem, but it has drawn a clear map of where the gaps are. By showing exactly where the roads are too long and where the specialists are too few, it provides a foundation for building a system where every baby, regardless of where they are born, has a fair chance at a future with sight.