Retinopathy of Prematurity (ROP) is a blinding disorder affecting children caused by abnormal growth of the blood vessels of the retina. This disease affects children who are prematurely born before 34 weeks of pregnancy (against the normal term of 38 – 42 weeks). Children with retinopathy are born underweight with weight ranging much below 2000 gms. When a baby is born prematurely, retinal blood vessels can grow abnormally, causing damage to the retina. Both the eyes of the child may be affected which can eventually lead to life-long impaired vision or blindness.

Causes and effects:

Usually, the retinal blood vessels in the child’s eye starts developing after the first 16 weeks of pregnancy. The development of the eyes is fastest during the last 12 weeks of a full-term pregnancy. However, if the child is prematurely born, there could be inadequate development of the child’s retinal blood vessels. This leads to non-supply of enough oxygen and nutrients and abnormal formation of blood vessels. The abnormal retinal blood vessels can cause bleeding, retinal detachment, visual impairment, and blindness.

Identification

The Retinopathy in the new born infant is identified by a dilated fundus examination around 4 weeks after birth. Examination may be preponed by 1 week (That is at 3 weeks) in case of very low birth weight babies and  those born very early.

Management:

Management of cases of ROP involves coordination between, the neonatologist, ophthalmologist and the NICU staff

Process of examination

For clinical examination of the child for retinopathy syndrome, few drops of diluted drops are administered to the child 30 – 45 minutes before the actual examination. This process enables observation of abnormalities inside the eye of the infant.

• The retina of the child may be fully matured ensuring that the baby is safe. Follow-up checks are advised after 6 months.
• The retina of the child may not be fully developed.
• The ROP has affected the child but is not severe. Such children will be advised to close follow-ups.
• The last possibility is ROP has severely affected children thereby necessitating the need for laser / intraocular injections/surgery.

Benefits of Laser :  

ROP is a very rapidly progressing disease and hence any delay in treatment will severely impair the sight of the child. The recovery period of the ROP disease depends upon the child’s systemic condition, which once it gets stabilized, ensures total recovery. If the ROP has not affected the central part of the retina, the child will regain full vision. Only in severe cases the success of treatment will be lesser.

Statistically, it is noted that in the USA 3.9 million children are born every year of which around less than 1% of children have ROP. Most children get cured with only around 500 – 600 children becoming blind in the USA alone.

Awareness in India:

Around 38 million children are born every year in India of which nearly around 33% of the children are prematurely born. In India, the awareness of this disease is not widely spread, especially in rural areas.

Dr.Tandava Krishnan
Vitreo retinal surgeon
MaxiVision super specialty Eye Hospital
Hyderabad, Telangana state

The post Retinopathy of prematurity among infants- early treatment is necessary appeared first on Health Vision.

ROP is not a new disease but the number of babies at risk for ROP is increasing because of the improvement in neonatal care and better practices in NICU. As such the management of babies with ROP is a combined effort of neonatologists, ophthalmologists and a host of other health care personnel. Accordingly the theme for the World prematurity day 2020 which falls on 17^th November is “Together for babies born too soon – Caring for the future”

Which babies are at risk for ROP?

There are many guidelines with regard to ROP. The guidelines stated below are best suited for Indian babies

• Children born with birth weight less than 2000 grams·
• Children born before gestational age of 34 weeks·
• Children who have been exposed to oxygen for more than 30 days

Other factors where screening must be done for children with birth weight <2000 grams or Gestational age < 37 weeks include·      

• Respiratory distress syndrome·
• Multiple blood transfusions·
• Infection·
• Apnoeic episodes·
• Multiple births·
• Intraventricular haemorrhage·
• Any other case where the paediatrician has concerns

When to screen for ROP?

All children must be screened at least once by 31 weeks gestational age or 3-4 weeks after birth (whichever is earlier)

If the baby has a birth weight < 1200grams or is born before 24 weeks gestational age, examination must be scheduled at 2- 3 weeks post-delivery.

There is no need for examination within 2 weeks of delivery as the normal retinal maturation would not be completed

Preparation for examination:

The baby must be dilated using half diluted commercially available tropicamide- phenylephrine combination.  Recently, some companies have come out with ready to use drops where the constituent drugs have been diluted to levels which are deemed safe for the babies. 2-3 instillations of drops are applied 5 minutes apart and examination must be done after 30 to 45 minutes. Any excess drops on cheek must be immediately wiped off to prevent systemic absorption.

What happens after the examination?

The eye specialist examining the baby would advise based on the findings inside the eye. The following outcomes would be possible

1. Retina is fully matured – Baby will need a follow up after 6 months or 1 year
2. Retina is immature but there is no ROP – Baby will need close follow up
3. ROP is present but is not severe – Baby will need close follow up
4. ROP is present and severe – Baby will need LASER / intraocular injections /surgery in any possible combination

Can we delay the LASER / Surgery as the baby is small?

Surgery/LASER cannot be delayed as ROP is a rapidly progressing condition and any delay might only end up causing the condition to worsen, however, both LASER and surgery would be conducted under strict monitoring keeping in mind the fragile state of the baby and hence will not affect the baby adversely.

Will the baby recover after the LASER/Surgery?

ROP is the manifestation of the baby’s systemic condition in the eye. Recovery after LASER/Surgery would depend upon how quickly the systemic condition stabilizes.

Will the baby have good vision after LASER/Surgery?

If intervention is done in the early stages of ROP, when the central part of the retina is not yet affected, vision is usually not affected. In the long term, the baby might need to use some glasses in the future but they will enjoy good vision with the same. If the ROP is severe or affects the central part of the eye, the visual outcome might be lesser.

However, one must remember that without any intervention, the child might have gone completely blind. So, in a nut shell all the babies at risk must be examined and those babies needing LASER/surgery must be treated at the earliest to get the best results for the baby.

Also Read: Beat-the-eye-strain-with-healthy-robust-food

Dr Tandava Krishnan
Vitreo retinal surgeon
Maxivision super specialty Eye Hospital
Hyderabad

The post Retinopathy of prematurity – is it a new disease and how to prevent blindness? appeared first on Health Vision.