Pediatric Retinopathy

Overview

The light-sensitive tissue at the back of your eye that conveys information about what you're seeing to your brain — can have a variety of effects on babies through adolescence. Their severity and treatment differ, which is why thorough diagnosis and skilled care are critical to minimize the impact these disorders have on your child's eyesight.

Retinal problems in children can differ significantly from those in adults, and there are certain factors that are particular to the therapy of pediatric retina patients. Despite substantial progress in our understanding of pediatric retinal disease, there is still much to learn about the physiology and therapy of these disorders.

Retinal diseases in children include:

 

What is Retinopathy of prematurity (ROP)?

Retinopathy of prematurity (ROP) is a potentially blinding condition caused by faulty retinal blood vessel formation in preterm newborns. The retina is the inner layer of the eye that receives light and converts it into visual information for the brain to process. Premature birth might cause irregular growth of the retinal blood vessels. The majority of ROP cures without causing retinal damage. When ROP is severe, the retina can tear away or detach from the wall of the eye, potentially resulting in blindness. Babies weighing 1250 grams or fewer and delivered before 31 weeks of gestation are most at danger.

The most major risk factors for the development of severe ROP are birth weight and gestational age. Anemia, poor weight gain, blood transfusion, respiratory distress, breathing issues, and the infant's general health are also connected with the existence of ROP. There is considerable study into the relationship between blood growth factor levels and ROP. Close monitoring has reduced the role of oxygen usage as a risk factor for ROP development. The severity of ROP is unaffected by light intensity.

 

How many infants have ROP?

Every year, around 3.9 million newborns are born in the United States. ROP affects around 14,000 people, with 90% having fairly minor illness. ROP affects around 1,100- 1,500 newborns in the United States each year, with 400-600 being legally blind as a result of the illness.

 

How does top affect my baby?

The majority of newborns with ROP see normally for their age. Vision is only jeopardized when ROP advances to the most severe phases. Fortunately, the majority of ROP cures without causing visual loss. The difficulty is that no one can tell which babies will thrive and which will struggle. The most significant elements in avoiding ROP-related visual loss are effective screening and prompt treatment.

 

What are the stages of ROP?

ROP is divided into five phases. These phases are used by doctors to determine the severity of ROP. Stages range from mild (stage 1) to severe (stage 5):

• Stages 1 and 2 — Babies at these phases typically improve without therapy and go on to have normal eyesight. Doctors will closely monitor newborns to see whether their ROP worsens.
• Stage 3 — Some babies who have stage 3 recover without therapy and go on to have normal eyesight. Others, on the other hand, require therapy to prevent aberrant blood vessels from injuring the retina and causing retinal detachment (an eye problem that can cause vision loss).
• Stage 4 — Babies in stage 4 have partially detached retinas and need treatment.
• Stage 5 — In stage 5, the retina totally detaches. Even with therapy, newborns in stage 5 may lose eyesight or become blind.

Stages 4 and 5 are both highly serious. Babies at these phases frequently require surgery, but even with therapy, they may experience visual loss. As a result, doctors frequently begin therapy at stage 3.

Babies at any stage may also become ill fast and require care. That is why it is critical that your child has their follow-up exams on time. Early detection and treatment of ROP is the most effective strategy to reduce the likelihood of significant complications.

 

What are the symptoms of ROP?

There are no visible symptoms of ROP. The retina may partially or totally peel away from its natural place at the back of the eye in severe instances of ROP. This is known as retinal detachment, and it can result in vision loss and blindness.

If your baby had ROP that caused damage, you may later notice that:

• Their eyes wander, shake, or make other unusual movements
• Their eyes don’t follow objects
• Their pupils look white
• They have trouble recognizing faces

Babies with ROP are also more prone to have additional eye disorders as they grow older, such as:

• Retinal detachment
• Nearsightedness
• Amblyopia (lazy eye)
• Crossed eyes

If your kid experienced ROP when they were younger, it is critical that they get frequent checks and eye examinations. Early detection and treatment of eye disorders will help safeguard your child's eyesight as they grow older.

 

How is ROP diagnosed?

ROP is diagnosed by ophthalmologists who are experts in evaluating infant eyes. They examine the eyes after dilating the pupils using drops. There is ongoing study into the usefulness of digital photography in the diagnosis of ROP. Infants weighing less than 1500 grams and with a gestational age of fewer than 31 weeks are subjected to ocular tests to screen for ROP. Other newborns judged high risk by the neonatologist may be checked as well.

 

What does treatment involve?

No parent wants his or her kid to be sick and learning that your newborn is having problems with something as important as his eyes may be extremely upsetting. However, at Children's, we regard the diagnosis as a beginning point: We can closely monitor the progression of ROP with early identification to decide the ideal moment to begin therapy, if necessary, for the best results for your baby's eyes.

If your kid has moderate retinopathy of prematurity (Stage 1 or 2), the aberrant retinal blood vessels will normally close on their own during the first four months of life. However, if his ROP worsens, he may require therapy.

The objective of therapy is to stop the aberrant blood vessel development in the eyes and reduce its negative consequences, such as scarring or retinal detachment.

 

Photocoagulation (laser therapy)

The first line of defense against ROP is photocoagulation. The procedure is similar to a retinal exam, except that your kid will be given local or general anesthetic. To inhibit future formation of aberrant blood vessels, the ophthalmologist uses a diode laser installed on an indirect ophthalmoscope to generate tiny "burns" in the periphery of the retina.

Your child's doctor will schedule follow-up checkups every one to two weeks to see how the eyes are reacting to the laser therapy. If your child's ROP worsens, he or she may require more laser treatments or perhaps eye surgery.

 

Cryopexy (cryotherapy)

Cryopexy, which was formerly the treatment of choice for ROP, employs a pen-like tool called a cryoprobe to freeze sections of the retina's periphery through the outer wall of the eye. Though laser treatment has mostly superseded it, cryopexy is beneficial when the retina cannot be viewed completely (because of a hemorrhage, for example)

Because photocoagulation and cryopexy both remove a portion of the retina's periphery, your kid may lose partial side vision as a result of these therapies. However, the technique tries to preserve his "central vision," or the most significant area of his eyesight, which is required for activities such as reading and driving.

 

Eye surgery

If your child's retina becomes partially or fully detached — Stage 4 or 5 — your doctor may refer him to a retinal surgeon for therapy, which often consists of scleral buckling or vitrectomy.

• Scleral buckling is performed by wrapping a silicone band around the eye and tightening it until the retina is near enough to the wall to reconnect. The band, known as a scleral buckle, can be remained in place for months or even years to protect the eye.
• The vitreous (the gel-like material that fills the back of the eye) is removed and replaced with saline solution or oil during a vitrectomy. The scar tissue on the retina can then be peeled back or sliced away, allowing the retina to flatten again against the eye wall.

 

Research to Prevent ROP

Smaller newborns have survived thanks to modern medical treatment in NICUs and special care facilities. Doctors are seeing more ROP because there are more preterm newborns than ever before.

ROP research is now being conducted at Nationwide Children's. These studies look at the treatment of severe ROP as well as the outcomes of children with mild or moderate ROP. Children with ROP who do not need therapy frequently have decent eyesight. They are occasionally impacted by the same scarring and retinal detachments as eyes with severe ROP. Some ROP youngsters require glasses sooner than children who were not preterm and did not have ROP. We aim to one day avoid all visual loss caused by this condition.

 

Follow-Up Appointments

Follow-up checkups are critical for monitoring your infant's eye therapy and progress. When your infant is discharged, make sure to ask your doctor or nurse about your next appointment. These appointments may be daily or weekly at first, then less frequently if your baby is doing well. Exam scheduling is critical. Missed visits may cause treatment to be delayed.

It is critical that you provide your current phone number and address to your child's care team so that the ophthalmologist's office may contact you about appointments and newborn updates.

 

Other pediatric retinal diseases

• Detached Retina

Occurs when the retina detaches from the back of the eye. It may result from trauma or disease.

• Juvenile Macular Degeneration

A hereditary condition characterized by the breakdown of the macula; the portion of the retina responsible for central vision. Stargardt illness is the most frequent kind.

• Retinoblastoma

An eye cancer that begins in the retina, typically in young children.

• Uveitis

A rare, complex condition that can cause chronic inflammation in the front, middle or back of the eye.

 

FAQ

1. Do all babies born prematurely get ROP?

No, blood vessels continue to grow normally in about one out of every two preemies (although finishing the job a few weeks later than the original due date).

    2. How common is severe ROP?

Each year, around 1,100 to 1,500 (about 10%) of the estimated 14,000 preterm newborns born with ROP in the United States develop illness severe enough to require medical treatment. ROP causes around 400-600 newborns to become legally blind.

    3. Can ROP get better or heal on its own?

Yes. This is known as disease "regression," and it is most common in moderate ROP (Stage 1 and 2). It can also occur in more severe ROP, although even when the aberrant blood vessels disappear, there may still retinal scarring that must be continuously monitored.

    4. Does ROP always happen in both eyes?

Both yes and no: While this condition usually affects both eyes, it might be more severe in one than the other. Doctors may occasionally need to treat only one eye.

    5. How accurate is ROP screening?

According to the American Academy of Pediatrics, which establishes screening criteria, retinal examinations performed by a pediatric ophthalmologist may detect the illness with roughly 99 % accuracy.

    6. Does a diagnosis of ROP mean my baby has to stay in the hospital longer?

Because ROP screening does not begin until a preterm newborn is four to nine weeks old, your kid may be released from the NICU before his first screening check. If he is diagnosed with ROP while still in the NICU, you should be able to take him home on time. Through follow-up tests, your physicians will monitor how his ROP evolves and decide whether to treat it.

    7. How is ROP treated?

Laser treatment or cryotherapy (freezing) can help reduce or correct aberrant blood vessel formation; nevertheless, in the most severe cases of ROP, ocular surgery may be required. There are currently no FDA-approved treatments to treat ROP, while various therapies are being researched.

    8. What are the possible complications of ROP?

Approximately 10% of premature newborns will require medical treatment, such as laser therapy (photocoagulation). However, not all newborns respond to therapy, and if the ROP worsens, it can lead to issues such as:

• Scarring and/or dragging of the retina
• Retinal detachment
• Bleeding inside the eye (vitreous hemorrhage)
• Cataracts
• Blindness

The remaining 90% of newborns have a moderate form of ROP that normally cures on its own within the first few months of life. These youngsters, however, may be more likely to develop certain eye disorders later in life, such as myopia (nearsightedness), strabismus (crossed eyes), amblyopia (lazy eye), and glaucoma.

    9. Can ROP be prevented?

Because the actual etiology of retinopathy of prematurity is unknown, prenatal treatment is the greatest way to lower the risk of preterm delivery. Although doctors cannot prevent ROP, they can help reduce its most severe consequences via thorough screening and treatment.

 

Conclusion 

Retinopathy of prematurity (ROP) is a condition in which aggressive new blood vessels (neovascularization) grow in the retina, causing blindness in preterm children with low birth weight and possibly progressing to retinal detachment. At a certain degree of severity, retinopathy of prematurity provides a significant risk of irreversible vision loss, necessitating laser therapy. In most situations, ROP laser therapy eliminates the illness by causing the aberrant blood vessels to vanish.