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Retinopathy of Prematurity

“Nature is a labyrinth in which the very haste you move with will make you lose your way.”
-    Sir Francis Bacon


Sometimes, due to one reason or the other, babies are born premature. If this haste does not go too well with nature, the prematurely born baby may be at the receiving end. One dead end that could turn up in this labyrinth if one gets lost is ROP…

What is the retina?

The retina is the inner lining of your eyeball, the light sensitive screen from where images are converted to impulses and sent to your brain for interpretation.

What is Retinopathy of Prematurity?

Retinopathy of Prematurity (ROP) is an eye disease seen in premature babies in which there is growth of abnormal blood vessels on their retina.
ROP usually affects the youngest, smallest and sickest of infants. The more premature and the smaller your baby is, the higher the chances of developing ROP.

 

What causes ROP?

When a baby is in its mother’s womb, the blood vessels in its eyes begin developing at 16 weeks and finish development in the last few weeks before birth. However, when a baby is born premature, these blood vessels do not get a chance to develop fully. The baby is then exposed to elements of the outside world like light and temperature changes, high levels of oxygen and medications, which are probably responsible for interfering with the normal development of blood vessels to cause ROP. The vessels grow abnormally into the gel inside the eye. Being fragile, these vessels can leak blood into the eye.

The following are factors that warrant an examination to rule out ROP:

(Screening Criteria):
• Low birth weight (below 2000 grams)
• Low gestational age (born before 35 weeks)
• Use of supplemental oxygen after birth
• Vitamin E deficiency
• Anemia (a condition in which blood has low blood red cells or low hemoglobin)
• Respiratory complications
• Blood transfusion
• Heart Disease

Does my child have ROP? (Signs and Symptoms)

In the initial stages, ROP does not show any signs or symptoms. (This is why early examination is a must to catch the disease before it progresses).

The following signs are seen in the advanced stages of the disease:

• White-looking pupils
• Severe nearsightedness
• Abnormal movements of the eye
• Crossed eyes

 

What are the tests for ROP?

Sometimes, ROP may not be detected for several weeks after birth. Hence it is very essential that all premature babies have their eyes tested before day 30 of life. Timely examination is of utmost importance to prevent loss of vision before it becomes too late.
ROP can be diagnosed by an eye examination.

 

What is the treatment for ROP?

ROP is divided into 5 stages according to the severity.

If the ROP is in the early stages (1 and 2), no treatment is required as it usually gets better on its own.

If the condition has advanced to stage 3 or beyond treatment is needed. Infants are treated at about 32 – 40 weeks. The following options are available:

• laser treatment (photocoagulation) is used to eliminate the abnormal blood vessels
• cryotherapy (freezing to prevent the abnormal blood vessels from spreading)
• eye glasses
• eye drops
• patching one eye (if amblyopia has to be treated)
• Scleral Buckling (placing a band around the eyeball) or Vitrectomy (removal of the gel inside the eye) surgery may be needed if the condition has reached stage 4 or 5 and retinal detachment has occurred.
 

What are the complications of ROP?

Sometimes, as your baby grows, the abnormal blood vessels may shrink without any treatment. While at other times, the vessels may develop further to cause serious eye problems like:

Retinal Detachment

Nearsightedness

Amblyopia (loss of vision in one eye because the brain blocks out images from a defective eye)

Glaucoma (damage to the optic nerve of the eye due to raised pressure inside the eyes)

Blindness or Loss of Vision

Vitreous Hemorrhage (Bleeding inside the eye): This usually clears up after a few weeks

Scar tissues inside the eye due to disease or treatment

Cataract

 

What is the prognosis?

Most infants with ROP recover without any lasting visual troubles.

Eyes that progress to stage 4 or 5 can go blind. Sometimes, the ROP may continue to worsen despite timely laser treatment. Eyes with retinal detachment have a poor prognosis.

Eyes treated at stage 2 or 3 may have a vision of 20/40 (it means that when they stand 20 feet away from the chart, they can see what a normal human can see while standing 40 feet away from the chart)

Whereas, those eyes that are treated at early stage 4 can see as well as 20/80 to 20/200

But it should be noted that, premature babies need a regular follow up irrespective of their ROP stage as incidence of myopia, lazy eye and squint is much higher in these babies as compared to term babies.