Posts Tagged ‘retinopathy of prematurity’

Retinopathy of prematurity

Friday, August 25th, 2017

If you have a premature baby, you may have heard of retinopathy of prematurity or ROP. ROP is an abnormal growth of blood vessels in the eye.

During the last 12 weeks of pregnancy, the eye develops quickly. When a baby is born full-term, the growth of the blood vessels that supply the retina is almost complete. The retina then typically finishes growing the first few weeks after birth.

However, if a baby is born too early, the blood vessels may stop growing or not grow correctly. These vessels can then leak and cause bleeding in the eye. Scar tissue forms, and if the scars shrink, they may pull the retina loose from the back of the eye. This is called retinal detachment. Retinal detachment is the main cause of vision problems and blindness in ROP.

Risk factors for ROP

Some babies are more likely to develop ROP. Risk factors include:

  • Premature birth. Although all premature babies are at risk for ROP, it occurs most often in babies born before 30 weeks of pregnancy.
  • Apnea. This is when a baby’s breathing stops for 15 to 20 seconds or more.
  • Anemia. This is when the body doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body.
  • Heart disease
  • Infection
  • Trouble breathing or respiratory distress
  • Slow heart rate (also called bradycardia)
  • Problems with the blood, including having blood transfusions.

How is ROP diagnosed?

Your baby will get a special eye exam for ROP if she:

  • Was born before 30 weeks
  • Weighed less than 3 pounds at birth
  • Has any other risk factors for ROP

A pediatric ophthalmologist will examine your baby’s eyes. Babies born at 27 weeks or later usually have their first eye exam when they’re 4 weeks old. Babies born before 27 weeks usually have the exam later, because the more premature a baby is at birth, the longer it takes to develop serious ROP. Because ROP can develop later, it’s very important to take your baby to all of her eye exams, even after she is home from the NICU.

If your baby’s first eye exam shows that the blood vessels in both retinas have finished normal development, she doesn’t need a follow-up exam. If your baby’s eye exam shows that she has ROP and needs treatment, she should start treatment within 72 hours. Early treatment gives your baby the best chance of having healthy vision.

Treatment

Most mild cases of ROP heal without treatment and with little or no vision loss. In more severe cases, the ophthalmologist may perform laser therapy or do a procedure called cryotherapy (freezing) to eliminate abnormal blood vessels and scars. Both treatments help protect the retina.

If your baby has ROP, visit our online community at Share Your Story to connect with other parents for support and comfort throughout your baby’s treatment.

Have questions? Email us at AskUs@marchofdimes.org.

Understanding retinopathy of prematurity (ROP)

Friday, November 4th, 2016

baby-eyesRetinopathy of prematurity is an abnormal growth of blood vessels in the eye. It mainly affects babies weighing about 2¾ pounds (1250 grams) or who are born before 31 weeks of pregnancy. ROP affects about 14,000-16,000 babies in the United States each year. If your baby has ROP, getting treatment right away is really important. The disease can develop very quickly and cause vision problems or even blindness if it’s not treated.

What causes ROP?

During the last 12 weeks of pregnancy, the eye develops quickly. When a baby is born full-term, the growth of the blood vessels that supply the retina is almost complete. The retina then typically finishes growing the first few weeks after birth.

However, if a baby is born too early, the blood vessels may stop growing or not grow correctly. Scientists believe that the edge of the retina then sends signals to other areas of the retina for nourishment. This results in abnormal vessels growing. These abnormal vessels are fragile and can bleed easily and cause retinal scarring. If the scars shrink, they pull on the retina and cause it to detach.

Risk factors for ROP

Some things make a baby more likely than others to have ROP. They include:

  • Premature birth.
  • Apnea. This is when a baby’s breathing stops for 15 to 20 seconds or more.
  • Anemia. This is when the body doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body.
  • Heart disease
  • Infection
  • Trouble breathing or respiratory distress
  • Slow heart rate (also called bradycardia)
  • Problems with the blood, including having blood transfusions.

Stages of ROP

ROP is classified into 5 stages:

  • Stage 1 – Mildly abnormal blood vessel growth. These babies often get better without treatment and go on to have healthy vision.
  • Stage 2 – Moderately abnormal blood vessel growth. These babies often get better without treatment and go on to have healthy vision.
  • Stage 3 – Severely abnormal blood vessel growth. Some of these babies get better without treatment, but others develop a condition called plus disease. This means the retina’s blood vessels get big and twisted. Plus disease is a sign that ROP is getting worse, but treatment can help prevent retinal detachment.
  • Stage 4 – Severely abnormal blood vessel growth and part of the retina detaches. These babies need treatment because part of the retina pulls away from the inside wall of the eyeball.
  • Stage 5 – Total retinal detachment. The retina is completely pulled away from the inside wall of the eyeball. Without treatment, a baby can have severe vision problems or blindness.

Treatment options

Laser or cryotherapy are the most effective treatments for ROP. Laser treatment uses a laser to burn and scar the sides of the retina. This stops abnormal blood vessel growth and prevents scarring and pulling on the retina. Cryotherapy uses a metal probe to freeze the sides of the retina, thereby preventing additional blood vessel growth.

Laser treatments and cryotherapy are done on babies with more advanced ROP, such as stage III.

Later stages of ROP require more intense treatments. Scleral buckle involves placing a silicone band around the white of your baby’s eye (called the sclera). This band helps push the eye in so that the retina stays along the wall of the eye. The buckle is removed later as the eye grows. If it isn’t removed, a child can become nearsighted. This means he has trouble seeing things that are far away.

In a vitrectomy, the doctor removes the clear gel in the center of your baby’s eye (called the vitreous) and puts saline (salt) solution in its place. Your baby’s provider can then take out scar tissue, so that the retina doesn’t pull. Only babies with stage 5 ROP have this surgery.

About 90% of infants with ROP fall into the mild categories and do not need treatment. But ROP can get worse quickly so early diagnosis and appropriate treatment (if needed) are very important. Your baby should be seen by a pediatric ophthalmologist. This is a doctor who identifies and treats eye problems in babies and children. The first eye exam should take place 4 to 9 weeks after birth, depending on when your baby was born.

You can read more about ROP on our website.

If your baby has ROP, visit our online community at Share Your Story to find a network of parents of babies with ROP. You can connect with them for support and comfort throughout your baby’s treatment.

Have questions? Text or email us at AskUs@marchofdimes.org.

Eye care for your child

Friday, August 15th, 2014

baby-eyesTaking care of your eyes is very important at all ages. Visual information helps children develop and to process the world around them from the time they are babies. Difficulty seeing can result in problems in learning as well as relating to the outside world. Most vision problems can be treated and corrected, but it is important to identify them as early as possible.

The American Academy of Pediatrics (AAP) as well as the American Academy of Ophthalmology recommend regular vision checks:

Newborns
The first vision exam should occur before your baby even leaves the hospital nursery. Newborns should have their eyes checked for infections, structural defects, cataracts, or congenital glaucoma.

Premature infants will need a special eye exam done by a pediatric ophthalmologist. A pediatric ophthalmologist is an eye doctor trained and experienced in the care of children’s eye problems.  Preemies are at risk for a condition called retinopathy of prematurity (ROP). ROP happens when a baby’s retinas don’t fully develop in the weeks after birth. The retina is the nerve tissue that lines the back of the eye. ROP usually affects both eyes. If your baby has ROP, getting treatment right away is very important.

Six months
Pediatricians should screen infants during their well-baby check-ups to make sure they have proper eye alignment. This means that their eyes are working together. They should continue to look for signs of eye disease.

Three to four years
At this age, both the eyes and vision should be examined by your child’s health care provider for any abnormalities that may cause a problem with educational development. Concerns will result in a referral to a pediatric ophthalmologist.

Five years and older
Regular screening of visual acuity and other eye functions should be completed every year during the well-child exam. The visual acuity test is used to determine the smallest letters you can read on a standardized chart or a card held 20 feet away. There are other ways to check vision in very young children if they do not yet know their letters or numbers.

Although routine eye exams are important, as a parent you may notice signs that your child is having difficulty seeing. According to AAP, some of the signs that a child may have a vision problem include:
• sensitivity to light
• poor focusing and poor visual tracking (following an object)
• abnormal alignment or movement of the eyes (after 6 months of age)
• persistent (lasting more than 24 hours) redness, swelling, crusting, or discharge in the eyes
• excessive tearing of the eyes
• frequent squinting
• drooping of one or both eyelids
• pupils (the center circle of the eye) of unequal size
• eyes that “bounce” or “dance”
• inability to see objects unless they are held close
• a white pupil instead of black in one or both eyes
• any cloudiness in the eye

If you notice any of these symptoms, make sure you contact your child’s health care provider right away. If caught early, many eye problems can be treated and corrected.

Click here to read more News Moms Need blog posts on: pregnancy, pre-pregnancy, infant and child care, help for your child with delays or disabilities, and other hot topics.

Researching preemie eye problems

Monday, January 23rd, 2012

isolette2Premature babies can struggle with many different health problems that come as a result of their early birth. Retinopathy of Prematurity (ROP) is one of them. ROP is an abnormal growth of blood vessels in the eye. It occurs in babies born before 32 weeks of pregnancy. ROP can lead to bleeding and scarring that can damage the eye’s retina (the lining at the rear of the eye that relays messages to the brain). This can result in vision loss.

It is very important that every baby with ROP have frequent follow-up exams, even if this extends beyond hospital discharge, until the ROP disappears.

Terrifying as a diagnosis of ROP may be, the good news is that most mild cases heal without treatment, with little or no vision loss. The abnormal blood vessels shrink and disappear. In more severe cases, the ophthalmologist may perform laser therapy or do a procedure called cryotherapy (freezing) to eliminate abnormal blood vessels and scars. Both treatments help protect the retina.

The March of Dimes is funding research into possible ways of preventing ROP.  Kip Connor, PhD, Children’s Hospital, Boston, is studying the role of omega-3 fatty acids (nutrients found in certain fatty fish) in preventing abnormal growth of blood vessels in the eye that can lead to retinopathy of prematurity. This study could possibly lead to nutritional treatments that could help prevent ROP.  We’ll keep you posted on Dr. Connor’s progress.

New drug treatment for ROP?

Friday, February 18th, 2011

Retinopathy of Prematurity (ROP) is an abnormal growth of blood vessels in the eye. It occurs in babies born before 32 weeks of pregnancy. ROP can lead to bleeding and scarring that can damage the eye’s retina (the lining at the rear of the eye that relays messages to the brain). This can result in vision loss.

An ophthalmologist (eye doctor) will examine the baby’s eyes for signs of ROP. Most mild cases heal without treatment, with little or no vision loss. In more severe cases, however, the ophthalmologist may perform laser therapy or do a procedure called cryotherapy (freezing) to eliminate abnormal blood vessels and scars. Both treatments help protect the retina, but can have complications or side effects.

Some babies with ROP may soon have an alternative to laser or cryosurgery, according to an article published this week in the New England Journal of Medicine.  A drug, bevacizumab (also called Avastin), used against some cancers because it inhibits vessel growth, was tested in infants with ROP.

In the study, 143 babies with ROP received either laser surgery or were administered bevacizumab. Of these infants, 64 had ROP centered around the optic nerve (Zone 1), and 79 had abnormal vessel growth outside that area. In the Zone 1 group, the babies benefitted much more from bevacizumab than they did  from laser surgery, as evidenced in the ROP recurrence rate several months later.  (The Zone 1 group had two out of 31 recurrences, while the laser surgery had 14 out of 33 babies showing a recurrence.) The 79 infants with ROP outside of Zone 1, however, showed no significant difference in outcome from either therapy.

This is an exciting and promising study, but it is still too soon to know the long-term effects of this drug. What are the risks compared to the benefits? Follow-up research and confirmation of results is needed before this can become widely available, but this study does provide hope for treating one of the more disabling results of early premature birth.

Retinopathy of prematurity (ROP)

Monday, September 20th, 2010

baby-eyesWhen a premature baby is born very early, his eyes are not fully developed.  As with other organs, it takes weeks for the eyes to continue to completely mature.

During normal eye development, a network of little blood vessels forms at the center of the retina in the back of the eye. Over time, the blood vessels spread and cover the surface of the retina, moving toward the front of the eye, carrying much needed oxygen.  This process is complete around the time of full term birth.

ROP is an abnormal growth of blood vessels in the eye. It occurs only in babies born before 32 weeks of pregnancy. The flow of oxygen throughout the eye can be slowed or accelerated due to the air the baby is receiving.  Respiratory distress and apnea episodes can reduce the flow while extra oxygen a baby may be receiving can increase the flow.  This change in oxygen flow can cause new, abnormal vessels to grow. ROP can lead to bleeding and scarring that can damage the eye’s retina (the lining at the rear of the eye that relays messages to the brain). This can result in vision loss. An ophthalmologist (eye doctor) will examine the baby’s eyes for signs of ROP.

Most NICUs have a screening program for babies born before a certain gestational age.  The doctor will examine the baby’s eyes and if he sees any sign of ROP, he will classify it as a stage 1-5 (mild-severe).  While ROP can progress from a mild stage to a more severe stage, it may stop at any time and disappear entirely.  It is very important that every baby with ROP have frequent follow-up exams, even if this extends beyond hospital discharge, until the ROP disappears.

Terrifying as a diagnosis of ROP may be, the good news is that most mild cases heal without treatment, with little or no vision loss. The abnormal blood vessels shrink and disappear.  In more severe cases, the ophthalmologist may perform laser therapy or do a procedure called cryotherapy (freezing) to eliminate abnormal blood vessels and scars. Both treatments help protect the retina.

Don’t forget that Nov. 17th is Prematurity Awareness Day.  Got a blog? Help us raise awareness by joining Bloggers UNITE to Fight for Preemies.