Retinopathy of prematurity: an alarming threat for the premature newborns

Retinopathy of prematurity (ROP) is an eye disease in some premature infants born before 31 weeks (a full-term pregnancy is about 37 to 42 weeks).  It is a problem of the retina. The retina is a part of the eye that receives light and sends signals to the brain so we can see.

Blood vessels in the eyes normally finish developing a few weeks before birth. An infant who is born premature (especially before 32 weeks) and has a low birth weight (especially (1,500 grams) may get exposure to many different insults, like medicine, oxygen and various forms of breathing supports, blood transfusion, bright lights, temperature changes, etc. These insults may cause unwanted blood vessels to grow on the baby's retina, which can cause serious visual problems later.

Shortly after birth, all premature babies should be checked for ROP. An ophthalmologist can examine the infant's eyes. However, ROP might not be visible until several weeks after birth. So, premature babies at risk for ROP are usually checked by an ophthalmologist at 4 to 6 weeks after birth and again thereafter. Timely detection and treatment can help prevent permanent vision loss. Other infants who are thought to be high risk by the newborn specialist might also be screened with eye exams.

It is very important to have eye exams after discharge from the hospital if ROP screening may not be done before discharge. The timing of these exams is very important because delays in examination will delay treatment. Delay of treatment can increase the risk of vision loss from ROP since we are not able to tell whether the baby's ROP has got worse just by looking at him or her. Also, even with successful treatment of ROP, prematurity may lead to other vision problems.

Previously, night blindness from deficiency of vitamin A was the leading cause of blindness in our country. But with the extensive distribution of supplementary vitamin A, the problem has been resolved. Nowadays, ROP is the leading cause of blindness among the children in our country.

Bangladesh is one of the countries where premature birth is alarmingly high (16.2%), and among them, almost 30% suffer from some sort of visual impairment afterwards. The timing of diagnosis and the start of treatment is paramountly important in this issue. Here, the sooner the treatment can be started, the better the prognosis would be.

Thus, mass awareness and adequate screening of ROP among the premature newborns is essential.

The writers are the Assistant Professor of Neonatology, Abdul Malek Ukil Medical College, Noakhali, and Assistant Director, Civil Aviation Authority of Bangladesh (CAAB), Dhaka, respectively.

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