Retinopathy of prematurity (ROP, also known as retrolental fibroplasia, or RLF), is an eye disease that can affect babies who are born prematurely. If not timely treated, these babies may suffer complete blindness.
When an infant is born prematurely, the retina of the eye is still developing. ROP occurs when the retinal vessels in the eyes of a premature infant have not finished growing at the time of the infant’s birth. This can lead to abnormal vessel growth, bleeding of the vessels, or scarring of the existing vessels. Retinal scarring and bleeding can lead to retinal detachment, causing permanent blindness. It is estimated that 400 infants are blinded each year, and 4,300 infants have serious scarring to the retinas due to ROP. The disease is preventable and curable if diagnosed and treated in time. Early diagnosis and treatment of ROP are critical to prevent total blindness.
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Anatomy and Risk Factors
The blood vessels in a baby’s eyes begin developing in utero at 3 months and that development continues through birth. The development is disrupted when a baby is born early—the blood vessels can stop growing or, in severe cases, develop abnormally. Infants born at an early gestational age and low birthweight are at greatest risk for developing ROP.
There are also avoidable and preventable factors that contribute to the severity and progression of ROP, including:
- Prolonged administration of oxygen
- Excessive or high concentrations of oxygen use
- Asphyxia (lack of oxygen)
- Hypothermia (low body temperature)
- Acidosis (increased acid in the blood)
- Vitamin E deficiency
- Apnea (irregular breathing)
- Heart disease
- Respiratory disease
- Low heart rate (bradycardia)
- Blood transfusions
- Low blood oxygen or acidity
- High amounts of carbon dioxide in the blood
Doctors should screen all babies born sooner than 30 weeks or who weigh less than three pounds at birth and should consider screening when these other risk factors are present. Babies with this condition may show signs of crossed eyes, nearsightedness, abnormal eye movements, or whitish pupils. The only way to test for retinopathy of prematurity is with an eye exam, which may be performed as early as four weeks after birth. The scheduling of these eye exams is based on many factors, including the degree of prematurity. If the exams are not performed at the specified times, then irreversible injuries can occur.
Common ROP Injuries and Treatments
The degree of injury to a baby typically depends on how prematurely the baby was born. These injuries fall across a spectrum, ranging from nearsightedness to total vision loss. Babies who face this condition early in life are at a greater risk to eventually develop other eye conditions, including strabismus, glaucoma, cataracts, and myopia.
When retinopathy of prematurity is detected early, treatment can offer a chance for normal vision. Treatments include:
- Oxygen treatment
- Freezing to prevent abnormal blood vessels from spreading (cryotherapy)
- Laser therapy to prevent abnormal blood vessels from spreading (photocoagulation)
- Surgery to repair detached retinas
Babies who are born prematurely should be treated with oxygen, which can stimulate the growth of blood vessels in the eyes.
Did Medical Wrongdoing Contribute to the Severity of Your Child’s ROP?
Blindness from ROP is avoidable and can be prevented. When an infant is born prematurely, doctors and nurses play a vital role in limiting the severity of your baby’s ROP.
The severity of ROP is affected by:
- Improperly using oxygen therapy after an infant is born
- Negligent monitoring of oxygen administration to an infant
- Failure to identify infants at risk for ROP
- Failure to diagnose ROP in a timely manner
- Failure to treat ROP in a timely manner
- Failure to provide follow-up care
Because the most significant risk factor for ROP is prematurity, doctors must use best efforts to prevent babies from being born prematurely. That means that obstetricians must be aware of the risk factors for prematurity and must closely monitor the mother for signs of preterm labor. When preterm labor is identified, medicine can be used to stop contractions.
Failure to Identify and/or Treat ROP
When a baby has any of the risk factors for ROP, including prematurity, the obstetrician must instruct parents about the signs and symptoms of ROP, and the baby should be scheduled for eye screening tests. Those tests must be performed at very specific intervals in order to determine whether the blood vessels in the eye are fully developed, developing normally, or developing abnormally. Importantly, parents must follow the doctors’ instructions exactly, particularly about the timing of testing. If the baby’s ROP is not timely identified, the baby is at risk for severe injuries, including permanent vision loss.
When Retinopathy of Prematurity is diagnosed, the baby’s eye doctor (ophthalmologist) should treat the baby quickly, using modes of therapy including cryotherapy, laser therapy, and surgery, when necessary.