Retinopathy of prematurity: symptoms, causes, drugs, etc. • hello healthy

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Definition

What is retinopathy of prematurity?

Retinopathy of prematurity (ROP) or retinopathy of prematurity is a potentially blinding eye disorder. This condition mainly occurs in premature babies weighing 1250 grams or less, born before the 31st week of pregnancy (the gestation period considered term is 38-42 weeks). The smaller the baby at birth, the more likely it is to get ROP.

This disorder — which usually affects both eyes — is one of the most common causes of vision loss at an early age and can lead to lifelong visual impairment and blindness. ROP was first diagnosed in 1942.

How common is prematurity retinopathy?

Today, with advances in neonatal care, smaller and premature babies can be saved. These babies have a much higher risk of developing ROP. Not all premature babies get ROP. There are about 3.9 million babies born each year; of these, about 28,000 weigh 2¾ pounds or less. About 14,000-16,000 of these babies are exposed to some level of ROP.

This disease can improve and leave no permanent damage in cases of mild ROP. About 90 percent of all babies with ROP are in the mild category and do not need treatment. However, babies with more severe disease may develop vision problems or even blindness. Approximately 1,100-1500 babies each year are affected by ROP which is severe enough to require medical treatment. Approximately 400-600 babies in the US each year become legally blind because of ROP.

However, this can be overcome by reducing your risk factors. Talk to your doctor for more information.

Signs & symptoms

What are the signs and symptoms of retinopathy of prematurity?

There are five stages of ROP:

• Stage I: There is a slight abnormal growth of blood vessels.
• Stage II: The growth of blood vessels is quite abnormal.
• Stage III: The growth of blood vessels is very abnormal.
• Stage IV: The growth of blood vessels is very abnormal and there is a partially separated retina.
• Stage V: There is a complete retinal detachment

Changes in blood vessels cannot be seen with the eyes closed. An eye exam is needed to reveal the problem. Infants with ROP can be classified as having “additional disease” if the abnormal blood vessels match the images used to diagnose the condition. Symptoms of severe ROP include:

• abnormal eye movements
• cockeye
• severe nearsightedness
• white visible pupils (leukocoria)

When should I see a doctor?

Early diagnosis and treatment can prevent the worsening of retinopathy of prematurity and prevent other medical emergencies, so consult your doctor as soon as possible to prevent this serious condition.

If your baby experiences any of the signs or symptoms listed above, or has any questions, please consult a doctor. Everyone's body reacts differently. It is always best to discuss what is best for your situation with your doctor.

Cause

What causes retinopathy of prematurity?

ROP occurs when abnormal blood vessels grow and spread across the retina, the tissue that lines the back of the eye. These abnormal blood vessels are fragile and can leak, injuring the retina and pulling it out of position. This causes retinal detachment. Retinal detachment is the leading cause of visual impairment and blindness in ROP.

Several complex factors may be responsible for the development of ROP. The eye begins to develop around the 16th week of pregnancy, when retinal blood vessels begin to form in the optic nerve at the back of the eye. Blood vessels grow and gradually reach the edges of the retina, supplying oxygen and nutrients. During the last 12 weeks of pregnancy, the eyes develop rapidly. When the baby is born with full gestation, retinal vascular growth is mostly complete (the retina usually finishes growing a few weeks to a month after birth). However, if the baby is born prematurely, normal vessel growth can stop before these blood vessels reach the edges of the retina. The periphery of the retina may not be getting enough oxygen and nutrients.

Scientists believe that the periphery of the retina then sends signals to other areas of the retina for nourishment. As a result, abnormal blood vessels begin to grow. These new blood vessels are weak and can bleed, causing retinal injury. When it shrinks, this wound pulls on the retina, causing it to slide out of the back of the eye.

Risk factors

What increases my risk for retinopathy of prematurity?

Apart from weight at birth and how early the baby is born, other factors that contribute to the risk of ROP include anemia, blood transfusions, respiratory problems, difficulty breathing, and the baby's overall health.

The ROP epidemic occurred in the 1940s and early 1950s when hospital nurseries began using too much oxygen in incubators to save the lives of premature babies. During this time, ROP was the leading cause of blindness in US children. In 1954, scientists funded by the National Institutes of Health determined that the high levels of oxygen routinely given to premature infants at that time were an important risk factor, and that reduced levels of oxygen given to preterm infants reduced the incidence of ROP. With newer techniques and methods for monitoring infant oxygen levels, the use of oxygen as a risk factor has diminished significance.

Although it has been cited as a factor in the development of ROP, researchers supported by the National Eye Institute determined that lighting levels in hospital nurseries had no influence on the development of ROP.

Drugs & Medicines

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

How is retinopathy of prematurity diagnosed?

All preterm infants who entered the screening protocol defined as birth weight less than 1500 g and gestational age below 30 weeks were routinely examined for ROP. These premature babies are likely to be screened initially at four to six weeks after birth. The eye doctor will use eye drops to dilate the pupil, which allows him to see inside the eye more clearly.

Depending on the amount of abnormal blood vessel development, the baby's condition will be assessed and further tests will be carried out every one to two weeks, depending on various factors. These factors include the severity and location of the ROP in the eye, and the rate at which blood vessel formation progresses, called vascularity. In most of the cases, even as it progresses, ROP will resolve spontaneously with minimal impact on vision. However, the minority of infants screened for ROP, about 10%, will progress to the point where it is no longer safe to wait for spontaneous recovery. For these babies, medication will be offered to reverse the progression of ROP.

What are the treatments for retinopathy of prematurity?

The treatments shown to be most effective for ROP are laser therapy or cryotherapy. Laser therapy "burns down" the margins of the retina where there are no normal blood vessels. With cryotherapy, the doctor uses a device that produces freezing temperatures to briefly touch points on the surface of the eye that are located on the edge of the retina. Both laser treatment and cryotherapy destroy the periphery of the retina, slowing or reversing the growth of abnormal blood vessels. Unfortunately, this treatment also partially destroys side vision. This is done to save the most important part of vision, namely sharp central vision, which is needed in "forward" activities such as reading, sewing and driving.

Both laser treatment and cryotherapy are only performed in infants with advanced ROP, especially stage III with "additional disease." Both treatments are considered invasive surgery on the eye, and doctors don't know what the long-term side effects of each treatment are.

In the advanced stages of ROP, other treatment options include:

• Sclera belt

This involves placing silicone rubber around the eyes and securing them. This prevents the vitreous gel from pulling on the scar tissue and allows the retina to flatten back against the eye wall. Babies who have had a sclera belt will have to have the rubber removed months or years later, as the eyes continue to grow; otherwise they will become nearsighted. The sclera belt is usually performed on infants with stage IV or V.

• Vitrectomy

Vitrectomy involves removing the vitreous and replacing it with a saline solution. After the vitreous is removed, scar tissue on the retina can be peeled off or cut, allowing the retina to relax and lie back against the eye wall. Vitrectomy is only performed at stage V.

Home remedies

What are some lifestyle changes or home remedies that can be used to treat retinopathy of prematurity?

The best way to prevent ROP is to avoid premature birth. Prenatal care and counseling can help prevent preterm birth and inform the mother about the factors that affect the health of her unborn baby.

Other preventive interventions involve closely monitoring the oxygen demand of preterm infants. Regular eye exams should be discussed with the baby's doctor, regardless of the stage of ROP.

If you have any questions, consult your doctor to understand the best solution for you.