RETINOPATHY OF PREMATURITY · RETINOPATHY OF PREMATURITY Renopathy of Prematurity (ROP) is a...

NEWBORN CARE WEEK NOVEMBER 15-21

WORLD PREMATURITY DAY NOVEMBER 17

RETINOPATHYOFRETINOPATHYOFPREMATURITYPREMATURITY

RETINOPATHYOFPREMATURITY

PRETERMBABIESTOO,HAVETHERIGHTTOSIGHT

In the context of preven�ng

blindness in newborn babies,

Re�nopathyofPrematurity(ROP)

hasemergedasaseverechallenge

par�cularly in developing and

middle-incomegroupcountriesin

La�n America, Eastern Europe,

SouthEastAsia,ChinaandIndia.

ROP is a poten�ally avoidable

cause of irreversible and usually

totalblindnessinpretermbabies.

T h i s d i s e a s e h a s l i f e l o n g

implica�ons for afflicted children

andtheirfamilies.

India con�nues to lead with the

l a rge st n u m b e r o f v i s u a l l y

impaired and blind children,

globally.

Many countries like India are

expanding neonatal care but lack

sufficient knowledge, effec�ve

screening guidelines and bedside

programsforROP.

M o r e t h a n 6 0 % o f v i s u a l

i m p a i r m e nt s i n b a b i e s a re

preventableorcurablewith�mely

d e t e c � o n , p r o m p t a n d

appropr iate preven�ve and

cura�vemanagement.

The World Health Organiza�on

(WHO) has highlighted ROP as a

major target d i sease in i t s

preven�on of blindness program,

“VISION 2020: Right to Sight” to

combat need less b l indness

globallybytheyear2020.

Theprogramtargetsallbabiesat

risk for ROP, for screening eye

examina�ons and access to

treatmentforsevereROP.

PRETERMBABIESTOO,HAVETHERIGHTTOSIGHT

In the context of preven�ng

blindness in newborn babies,

hasemergedasaseverechallenge

par�cularly in developing and

middle-incomegroupcountriesin

La�n America, Eastern Europe,

SouthEastAsia,ChinaandIndia.

ROP is a poten�ally avoidable

cause of irreversible and usually

totalblindnessinpretermbabies.

T h i s d i s e a s e h a s l i f e l o n g

implica�ons for afflicted children

andtheirfamilies.

India con�nues to lead with the

l a rge st n u m b e r o f v i s u a l l y

impaired and blind children,

globally.

Many countries like India are

expanding neonatal care but lack

sufficient knowledge, effec�ve

screening guidelines and bedside

programsforROP.

M o r e t h a n 6 0 % o f v i s u a l

i m p a i r m e nt s i n b a b i e s a re

preventableorcurablewith�mely

d e t e c � o n , p r o m p t a n d

appropr iate preven�ve and

cura�vemanagement.

The World Health Organiza�on

(WHO) has highlighted ROP as a

major target d i sease in i t s

preven�on of blindness program,

“VISION 2020: Right to Sight” to

combat need less b l indness

globallybytheyear2020.

Theprogramtargetsallbabiesat

risk for ROP, for screening eye

examina�ons and access to

treatmentforsevereROP.

isadynamic,�me-bounddisease

thatisnotpresentatbirth.

The condi�on afflicts the eyes of

pretermbabiesthathavetypically

received hospital based neonatal

care (with or without oxygen

therapy) that helps to save their

life,butseverelyaffectstheireye

development.

Thecondi�on is characterizedby

development of abnormal blood

vessels in the re�na of the eye,

resul�ng in scarring and re�nal

detachment.

ROPcanbemildandmayresolve

spontaneously, but in serious

cases, may progress rapidly and

leadtoblindness.

ROPtypicallystartsonly2-3weeks

a�er birth, providing a window

periodforscreeningandini�a�ng

treatmentattheright�me,while

the baby is s�ll under neonatal

careatthehospital.

isadynamic,�me-bounddisease

thatisnotpresentatbirth.

The condi�on afflicts the eyes of

pretermbabiesthathavetypically

received hospital based neonatal

care (with or without oxygen

therapy) that helps to save their

life,butseverelyaffectstheireye

development.

Thecondi�on is characterizedby

development of abnormal blood

vessels in the re�na of the eye,

resul�ng in scarring and re�nal

detachment.

ROPcanbemildandmayresolve

spontaneously, but in serious

cases, may progress rapidly and

leadtoblindness.

ROPtypicallystartsonly2-3weeks

a�er birth, providing a window

periodforscreeningandini�a�ng

treatmentattheright�me,while

the baby is s�ll under neonatal

careatthehospital.

40CRITICALWEEKS

Thelasttwelveweeksofanormal

term gesta�on are crucial in the

developmentoffetaleyes.

The fetal re�na (�ssue that lines

the back of the eye) slowly

maturesinthemother'swombby

40weeks,whichisbytheexpected

dateofdelivery.

From 16 weeks to birth, re�nal

blood vessels grow out from the

op�cnervetoreachtheperipheral

re�na.

In preterm babies, the normal

growthofbloodvesselsstops.The

area without adequate blood

supplyemitsachemicaltriggerto

s�mulate growth of abnormal

vessels.

Theseabnormalbloodvesselsare

fragileandcan leadto forma�on

of a ring of scar �ssue that is

a�ached to both the re�na and

thevitreousgelthatfillsthecenter

oftheeyes.

Asthescar�ssuecontracts,itmay

pull the re�na out of posi�on,

crea�ngare�naldetachment.

Re�nal detachment is the prime

cause of visual impairment and

blindnessinROP.

40CRITICALWEEKS

Thelasttwelveweeksofanormal

term gesta�on are crucial in the

developmentoffetaleyes.

The fetal re�na (�ssue that lines

the back of the eye) slowly

maturesinthemother'swombby

40weeks,whichisbytheexpected

dateofdelivery.

From 16 weeks to birth, re�nal

blood vessels grow out from the

op�cnervetoreachtheperipheral

re�na.

In preterm babies, the normal

growthofbloodvesselsstops.The

area without adequate blood

supplyemitsachemicaltriggerto

s�mulate growth of abnormal

vessels.

Theseabnormalbloodvesselsare

fragileandcan leadto forma�on

of a ring of scar �ssue that is

a�ached to both the re�na and

thevitreousgelthatfillsthecenter

oftheeyes.

Asthescar�ssuecontracts,itmay

pull the re�na out of posi�on,

crea�ngare�naldetachment.

Re�nal detachment is the prime

cause of visual impairment and

blindnessinROP.

*TEESDINROSHNIKE !

Chronic hypoxia (lack of oxygen),

intrauterine growth retarda�on

and prenatal and postnatal

condi�onsarethemostcommon

triggersofROP.

Babies born under 34 weeksgesta�on and weighing less than2000 grams are par�cularlysuscep�ble to ROP and must bescreened within 20-30 days frombirth.

High levels of supplementaloxygen and high carbon dioxidelevelsarealsoknowntoaggravateROP.Duringneonatal incuba�on,pretermbabiesaretobeprovided

with blended oxygen, strictlycontrolled and monitored usingpulseoxymeters.

Other r i sk factors that areassociated with the condi�onincludeanemia,bradycardia (lowheartrate),bloodtransfusionsandintraven�cular hemorrhage(bleedingintothebrain).

Addi�onally, prenatal maternalfactorscompoundtheprobabilityof an ROP occurrence. Theseinclude infer�lity treatments,twinsandtriplets,heavysmoking,a n e m i a , d i a b e t e s a n dpreeclampsia.

*Thirtydaystovision!

*TEESDINROSHNIKE !

Chronic hypoxia (lack of oxygen),

intrauterine growth retarda�on

and prenatal and postnatal

condi�onsarethemostcommon

triggersofROP.

Babies born under 34 weeksgesta�on and weighing less than2000 grams are par�cularlysuscep�ble to ROP and must bescreened within 20-30 days frombirth.

High levels of supplementaloxygen and high carbon dioxidelevelsarealsoknowntoaggravateROP.Duringneonatal incuba�on,pretermbabiesaretobeprovided

with blended oxygen, strictlycontrolled and monitored usingpulseoxymeters.

Other r i sk factors that areassociated with the condi�onincludeanemia,bradycardia (lowheartrate),bloodtransfusionsandintraven�cular hemorrhage(bleedingintothebrain).

Addi�onally, prenatal maternalfactorscompoundtheprobabilityof an ROP occurrence. Theseinclude infer�lity treatments,twinsandtriplets,heavysmoking,a n e m i a , d i a b e t e s a n dpreeclampsia.

*Thirtydaystovision!

Newborncareunit:NearlyeverypretermbabyherewouldbeathighriskforROP.

BORNTOOSOON

E a r l y s t a g e s o f R O P, w h e r etreatment is effec�ve, have nosymptomsandtheeyelooksnormalfromtheoutside.

Hence, rou�ne re�nal screeningwithin3-4weeksofbirthistheonlyway to detect vision-threateningstagesofROP.

Preterm babies born at 23-27weeks should be examinedwithinthreeweeksofbirth.

Preterm babies born at orbeyond 28 weeks should beexaminedbythefourthweek,byDay-30oflife.

P reterm babies should beexaminedpriortodischargefromthe hospital if they are likely tomissafollow-upexamina�on.

During this period, most pretermbabiesareincri�calcareando�enincubatedinNeonatalIntensiveCareUnits (NICU) and Special NewbornCareUnits(SNCU).

Aneyespecialistmustbeappointedat the neonatal care hospital, toexamine the re�na of newborns.Caregiversneedtobegeareduptoc o n d u c t R O P s c re e n i n g a n dt r e a t m e n t i n s u c h a d v e r s esitua�ons.

For posi�ve outcomes, treatmentwithlaserphotocoagula�onmustbecarried out within 72 hours of

detec�onofthecondi�on.

F o l l o w - u p s c r e e n i n g a sr e c o m m e n d e d a � e r i n i � a lexamina�on must be st r ic t lyfollowedtoavoidirreversiblevisionloss.

Allpretermchildrenrunahigherriskindevelopingothereyeandvision-related complica�ons later in theirlives.

EvenpretermchildrenwithoutROPcondi�on are likely to developsquint, lazy eyes (amblyopia) andsignificant refrac�ve problems thatrequireprescrip�oneyeglasses.

Thus, bi-annual eye examina�onsare recommended for all pretermbabies born under 34 weeks orweighinglessthan2000grams.

The most effec�ve preven�on ofROPisthepreven�onofprematurebirththatiscurrentlynotpossible.Infactthese instancesareontherisepar�allyduetoassistedfer�liza�ontechniques that o�en result inprematureandmul�plebirths.

Preven�ng other complica�ons ofprematurity (such as neonatalrespiratory distress syndrome) mayalso help prevent ROP. Antenatalsteroids administered to high-riskmothers are one of the op�onsavailable.