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Eye Disease In Premature Babies

A baby enters the world all too soon. Her tiny body is ill-prepared to face the challenges beyond the safety of her mother’s womb.

Many of the health problems faced by premature infants are well-known, such as upper respiratory difficulties and underdeveloped motor skills. However, ocular problems in premature infants are not as widely understood. One such problem, retinopathy of prematurity (ROP), is the leading cause of blindness in children.

What is ROP?
ROP is an eye disease of premature babies that results from the abnormal development of the retina, the “seeing” part of the eye. The disease most often heals itself spontaneously, and normal retinal development occurs.

However, ROP may cause the development of abnormal blood vessels and partial or complete retinal detachment. If the retina detaches from the surface of the eye, blindness may result. ROP may also result in later visual complications, such as strabismus (crossed eyes), amblyopia (lazy eye), and myopia (nearsightedness), as well as late-onset retinal detachment.

Julia Stevens, M.D., associate professor, Department of Ophthalmology, University of Kentucky College of Medicine, has performed countless ROP examinations at UK. “Infants of less than 32 weeks gestational age (the amount of time in the womb), with a birthweight of less than 1,500 grams (approximately 3 pounds) are at risk for ROP,” says Stevens. “Those born at 23 to 28 weeks gestational age with a birthweight of less than 1,000 grams are at a particularly high risk for the disease.”

How rare is ROP?
ROP occurs in about 60 to 70 percent of infants born under 1,250 grams (a little under 3 pounds), but the majority have resolution and never need treatment. Also, it is quite common for ROP to get worse before it gets better.

Though parents may find that their babies have progressed disease at subsequent eye examinations, this does not always mean that they will progress to a level in which treatment is necessary.

How is ROP detected? A neonatologist, a doctor that specializes in treating newborns, will consult an ophthalmologist when it is appropriate for a premature infant to be examined for ROP. Examinations will normally begin four to six weeks after birth. The ophthalmologist will examine a child’s eyes and determine if the retinas are developing normally. If the early stages of ROP are detected, or if the retinas are not mature, the child should have regular examinations until the retina matures or ROP develops.

How is ROP treated?
Treatment will begin if a certain severity of ROP, known as threshold ROP, is detected. Options include laser treatment and surgery, and visual rehabilitation is crucial after treatment is concluded.

Laser treatment is usually recommended when an infant reaches threshold ROP, and it reduces the chance of blinding eye disease by 50 percent by eliminating abnormal blood vessels and their growth.

If laser treatment proves unsuccessful, and ROP progresses to retinal detachment, surgery will be necessary. Scleral buckling is a surgical technique that may be effective in repairing retinal detachments. A more often used treatment option now is vitrectomy. This involves removing the vitreous, or gel in which the abnormal vessels grow, and then removing the scar tissue and allowing the retina to reattach to the eye wall. The vitreous is replaced with a salt solution. There is some success with surgery for retinal detachment, but sight often remains limited. However, surgery may prevent total blindness.

Visual rehabilitation may be useful to a child with impaired vision due to ROP. Glasses or special low-vision lenses may be necessary to aid vision. Eye patching or eye muscle surgery may also be needed.

Can ROP be prevented?
The best way to prevent ROP is to prevent prematurity. Good prenatal care is extremely important. Also, parents of premature infants should be vigilant in seeing that their children receive proper eye evaluation and care.

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