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Magazine
EYECARE
Tender vision
DR. VASUMATHY VEDANTHAM, DR. MOHAN RAJAN
AND DR. SUJATHA MOHAN
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ROP is a blinding disorder in preterm babies which can be cured if detected early. An essential FAQ.
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Photo: Arunangsu Roy Chowdhury
Constant care: It is important to have regular eye check-ups.
Retinopathy of Prematurity (ROP) is a blinding disorder affecting the eyes of preterm babies. It has been identified as a priority area in WHO’s VISION 2020 programme with regard to childhood blindness. There has been an alarming increase in the incidence of ROP in the developing countries including India, constituting what is referred to as the third epidemic of ROP. While the incidence of ROP in the West is on the wane thanks to the improvement in neonatal care and screening, in India we are just beginning to face the storm. This is because of a paradoxical interplay of contrasting factors, namely, increased awareness leading to more numbers of treatable babies and decreased awareness leading to more babies with end stage disease. All this makes ROP an enormous problem in India. This article is aimed at increasing the awareness about this blinding condition, which, if detected early, results in complete cure and preservation of vision…
What is ROP?
ROP is a disorder in which new abnormal leaky blood vessels are formed in the eyes of preterm babies. If untreated, this results in exudation of blood and fluid into the retina, which is the light sensitive layer of the eye, leading to retinal detachment and blindness. It evolves in five stages from early ROP and progresses to either treatable ROP (threshold ROP) and retinal detachment or spontaneous regression.
How does it occur?
It occurs due to an interplay of many factors namely premature birth (birth of the baby a few weeks before the due date of delivery), low birth weight and a high sickness score and swings in blood oxygen levels. All these factors act in concert to result in aberrant vasculogenesis.
Which babies get affected by ROP?
Babies up to 35 weeks gestational age and up to 2,000 gm birth weight and a stormy neonatal period needing repeated ventilation or continuous oxygen administration have a high possibility of developing ROP.
How to identify the affected babies?
The babies at risk have to be identified by the treating paediatrician and referred for an ophthalmic evaluation. If the babies are too sick to be shifted out of the neonatal intensive care unit (NICU), the eye examination is carried out there itself. The evaluation has to be done by an ophthalmologist experienced in the management of ROP (retina specialist). The eyes of babies need to be dilated by eye drops (which are prediluted so as to not affect the eyes of these delicate babies.) Very often, ROP is detected only by serial examinations and the eye specialist would request for repeat examinations and suggest appropriate follow-up.
Is there any effective treatment?
Yes, threshold ROP can be very effectively managed by laser photocoagulation. This results in drying up of the bleeding within the eye. Laser is administered by the treating ophthalmologist and usually does not require any anaesthesia. This is done in the presence of a paediatrician who would ensure that the condition of the infant is stable. Babies with retinal detachment (end stage ROP) need surgery in the form of a vitrectomy with or without removal of the lens. However, parents need to know that results of vitrectomy are often not as good as laser since the latter procedure is often done as a last resort when the retina is badly damaged.
How long should these babies be followed up?
The babies who have developed ROP need life long follow-up with a paediatric ophthalmologist and retina specialist as they might require glasses, develop high pressures within the eyes or develop misdirection of eyes (squint) or retinal detachment later. All these conditions can appropriately be managed.
Can we make a difference?
Definitely! The parents and relatives of preterm babies need to be aware of the existence of this condition and request for an ophthalmic evaluation if it has not been done. They can seek clarifications from the treating paediatrician and eye specialist. They should be rigorous in bringing the babies for follow-up care as instructed by the eye specialist, as delay in treatment can result in blindness.
ROP is a blinding disorder which can completely be cured if detected early. It is very important that timely treatment is instituted which requires the concerted co-operation of parents, relatives, paediatrician and the treating ophthalmologist. It is also important to remember that these babies are not born blind due to ROP and are in fact born with potential for full vision. It is up to us to ensure that they retain the same throughout their lives.
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