Retinopathy of Prematurity: A Visually Impairing Disorder Name English 12 Section 35 Professor Marchbanks September 29, 2005

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1 Retinopathy of Prematurity: A Visually Impairing Disorder Name English 12 Section 35 Professor Marchbanks September 29, 2005

2 1 Retinopathy of prematurity (ROP) is a visually impairing disorder which occurs in premature infants due to the irregular blood vessel development in the retina and can lead to visual complications and blindness in the most severe cases. 1,2 ROP, initially known as retrolental fibroplasias (RLF), was discovered and diagnosed in 1942 for the first time and was also one of the leading causes in blindness of infants during the 1940s and 1950s. 3,4 Infants who develop ROP have white-colored pupils because of the expansion of gray, disconnected retinal tissue that forms behind the lens of the eye. 3 Both eyes are normally affected when ROP develops in a premature infant. 3 ROP occurs in 16% of all premature infants. 4 Approximately 90% of infants with ROP only develop the initial, less severe stages of ROP and do not need treatment. Out of the 10% of infants that develop a more severe form of ROP, 1100 to 1500 infants will need treatment, and 400 to 600 infants become blind per year. 1 When they first discovered ROP, doctors thought that it was caused by hyporexia. 5 Doctors used extra oxygen in incubators when infants were born prematurely, but as technology increased over the years, oxygen use for premature infants was better monitored and no longer thought to be the main cause of ROP. 2 Presently, the main cause of ROP is attributed to prematurity; therefore the lower the birth weight of a premature infant, the more likely they are to develop ROP. 5 Infants who are most likely to contract ROP weigh less than 2 _ pounds and are born before 31 weeks of gestation. 1 Other factors that contribute to ROP include: anemia, blood transfusions, respiratory distress, breathing difficulties, and the infant s general health. 1 The reason prematurity and low birth weight have such a huge impact on the development of ROP is that the retinal blood vessels begin to develop 3 months after conception and continue to grow until birth. 2 In normal growth, the vessels grow towards the edges of the

3 2 retina to supply oxygen and nutrients to the growth of the eye and when an infant is born prematurely, this normal growth comes to a halt and therefore the process is disrupted. 1,2 When the process is interrupted, abnormal blood vessels begin to grow that can bleed, scar, and eventually cause retinal detachment, the fifth and final state of ROP. 1 In the initial stage of ROP, abnormal blood vessels begin to grow in the retina. In the second stage, growth of the abnormal blood vessels continues. In the initial two stages, the development sometimes stops and improves on its own with little to no treatment. By the third stage, blood vessels begin to grow towards the center of the eye rather than growing along the retina as in normal growth. At this stage, self-correction is still possible, but many infants develop plus disease during stage three when the blood vessels being to expand and contort. Once a child develops plus disease, treatment is needed to improve the condition. In stage four, abnormal blood vessels may begin to bleed, which can then cause scarring. The scarring causes the retina to begin to detach from the wall of the eye. In the fifth and final stage, the retina detaches completely. In the final stages, treatment is vital to salvage the infant s vision. 1 Visual complications that occur due to ROP include retinal detachment, myopia, strabismus, amblyopia, glaucoma, and blindness. 1 Depth perception can also be lost as a result of vision loss and cataract or corneal problems can potentially form. Glaucoma may also form later on in life; it does not always form right after the development of ROP. Nystagmus and phthisis bulbi complications may also develop if there is significant vision loss. 4 According to Allrefer Health (2002), children with ROP develop other complications of prematurity and require a multi-disciplinary approach to rehabilitation. 2 Even in the most severe cases where blindness occurs with few other complications, blind children are still capable of developing at approximately the same rate as children with no visual complications.

4 3 Blind children rely on their auditory and tactile senses as opposed to their visual sense to develop a sense of mobility, therefore learning to reach out for objects, crawl, and eventually walk are somewhat delayed. A sense of object permanence helps infants develop mobility and vision is the main tool in helping infants develop this concept, therefore blind children must use auditory cues to learn to reach out for different objects, delaying their mobility. Blind children learn to walk at approximately 18 to 24 months. 4 Other motor developments that do not involve movement through space do occur at a similar age as sighted children. Most blind infants are thought to develop cognitively at the same rate as sighted children, but are at high risk for emotional and behavioral problems. 4 My sister, Sarah, and her husband John were expecting their first child this fall. Sarah was due the beginning of September and they were both ecstatic about starting a family. They were counting down the months until their baby would be born and Sarah was on the ball, always going to her regular check-ups and keeping track of the condition of the baby. Sarah did everything possible to make sure that she would have a healthy baby in September. Sarah s water broke one night, three months before she was due. She had her baby in the early morning and it was a beautiful little girl, Lisa, only weighing approximately two pounds. Being so premature and having such a low birth weight, the doctors immediately concluded that she could possibly develop ROP. Lisa was visually not responding to stimuli that a normal infant should, and therefore it was concluded that she was developing visual complications. She had several check-ups monitoring her eye development and they noticed her pupils beginning to appear white colored, a sign of ROP development. The ROP reached the plus disease in the third stage when John, Sarah, and the doctors decided it would be necessary to have laser therapy performed on baby Lisa in hopes of

5 4 preventing her from losing her vision. Despite being premature and developing ROP, she was healthy and had not developed any other complications. They will be performing the laser therapy on Lisa within the next month. If the laser therapy performed on Lisa is successful, she will recover quickly and hopefully regain her vision. With regular check-ups monitoring her eyes and their development after the therapy is performed, her central vision can be saved. The therapy will give John and Sarah hope that Lisa will be able to develop like a normal, sighted child. I know that with this treatment, my niece will learn to walk, eventually read, and in the very distant future learn how to drive, just like any other child. ROP can and does self correct in the early stages and infants may not develop any complications. Unfortunately, when ROP reaches the more severe stages, however, treatment is necessary to help prevent vision loss. Laser therapy and cryotherapy are the main forms of treatment of ROP. 2 In laser therapy, the abnormal blood vessels that develop on the outsides of the retina are treated but this process must be performed early to be the most effective. In cryotherapy, freezing technology is used to correct abnormal blood vessels as well. Treatment can disturb peripheral vision but can save central vision, which is important for many everyday activities such as reading and driving. 1 With advanced technology, laser treatment can be performed on infants with ROP right after birth. 2 I have learned that there is always hope for children with ROP. To begin with, not all premature infants will develop ROP. 1 Early detection, prevention, and treatment are all possible ways to save an infant s vision, and ROP does not always result in blindness. The early stages can resolve with little to no treatment and if treatment of some form is needed, it can save the central vision that is essential for future development.

6 5 References 1 Retinopathy of Prematurity (ROP) [Internet]. Bethesda, MD: National Eye Institute; [updated 2005 April; cited 2005 Sept 3]. Available from: 2 Retinopathy of Prematurity [Internet]. Philadelphia, PA: AllRefer Health; c2002 [cited 2005 Sept 3]. Available from: 3 Silverman WA. Retrolental fibroplasias: a modern parable. New York: Grune and Stratton; p. 4Windsor RL, Windsor LK. Understanding Retinopathy of Prematurity [Internet]. [place unknown]: The Low Vision Gateway; c1995 [cited 2005 Sept 22]. Available from: 5 Flynn JT, Phelps DL, editors. Retinopathy of prematurity: problem and challenge. New York: Alan R. Liss; p.

Retinopathy Of Prematurity (or) Retrolental Fibroplasia )

Medical Information Document On Retinopathy Of Prematurity (or) Retrolental Fibroplasia ) What we see is made in the brain from signals given to it by the eyes. What we see is in fact made in the brain.