Retinopathy of Prematurity: Its Causes and Treatments
Retinopathy of Prematurity: Its Causes and Treatments
By Rochelle Caviness - Updated December 7, 2003
Retinopathy of Prematurity (ROP) is a disease that afflicts primarily premature infants, although there have been reports of full-term babies developing ROP. ROP is the leading cause of blindness in children, in the U.S.
What causes ROP to develop is not entirely clear, however there are some factors which make an infant at a higher risk of developing ROP, these include:
The Fetal Eye
- Premature birth
- Low birth weight
- Fluorescent lights being used in the neonatal unit.
- Too much or too little oxygen being used in the child's incubator.
- Risk factors may also include such variables as temperature and vitamin deficiencies.
The last trimester is a vital period in the development of an infant's eyes. Around the 16th week of gestation, blood vessels begin to grow outward from the optic nerve, branching out to cover the retina. This process is usually completed by the 36th week. When a baby is born prematurely, the blood vessels covering the retinas have not had a chance to fully develop. Often the premature birth will abruptly halt the progression of normal blood vessels, and the growth of abnormal vessels will commence. Vision loss may develop because these abnormal vessels may be unable to adequately carry oxygen efficiently, which will starve the retina making it unable to function properly. These abnormal vessels may also leak blood, which can lead to the build up of fluid in the eye. They may also cause the formation of scare tissue which can block vision or which, when it contracts, can cause the retina to tear or to become detached.
The Stages of ROP
- Most premature infants never develop ROP.
- Of those that do develop ROP, most cases spontaneously resolve themselves and the child develops normal vision.
Children with ROP are classified according to the severity of their condition. The International Classification of Retinopathy of Prematurity (ICROP) was developed in order to provide an international standard by which to grade a child's condition.
ROP develops in stages. As a child's condition worsens, they progress up the scale from stage I to stage V. Anywhere along this scale, the child's condition may stabilize or even regress to a better stage. Most children with ROP are classed within the Stage I and II categories.
Those with Stage I or II ROP normally have only minimal vision loss, and this can often be corrected with glasses.
Stage III individuals often have an abundance of abnormal blood vessels in the retina, and scaring is often present. At this stage, there is still a chance that the child will develop correctable vision.
Stage IV means that the child has suffered a retina tear or partial detachment due to the build up of fluids due. If the tear or detachment is caught in time, there is a possibility that it can be repaired. Visual impairment or blindness may develop, depending upon the severity of the detachment and whether or not it can be corrected.
Stage V refers to cases in which the entire retina has become detached. This usually results in blindness, even if the detachment is repaired.
Treatment for ROP
Depending upon the severity of a child's condition, there is the possibility that they can be helped simply with glasses, or they may require laser surgery. In some instances, even with surgery, the prognosis for the restoration of sight is poor.
Early diagnosis and prompt treatment offers a child the best chance of a good outcome.
Routine eye exams for Premature infants should be standard in all hospitals. Thereafter, the child should be examined again at six months and at least yearly thereafter.
Long Term Effects of ROP
Even if your child's ROP regresses, there are still long term risks that you need to be aware of. Children with ROP are more likely to develop other vision problems such as myopia, lazy eye, retinal detachments, cataract, glaucoma, or strabismus. These problems may not manifest themselves until the child reaches their teenage or even adult years. Therefore, it is vitally important that your child receive regular eye exams.
Retrolental Fibroplasia (RLF) is a disease that, in modern times, is more often classified as a form of ROP, rather than as a separate disease. RLF refers primarily to vision loss that was induced by high levels of oxygen in an incubator. This was a major problem throughout the 1940's and 1950's. Currently, oxygen levels in incubators are stringently monitored to minimize the risks to children associated with oxygen levels being too high or too low.
This article is for information purposes only, always consult your doctor for medical advice.
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