Neonatal Eyes Problems

Retinopathy of prematurity is a potentially blinding complication of preterm birth. The condition starts within a few weeks of birth and can progress rapidly over the following few weeks, or regress spontaneously. The international classification describes 5 stages, 3 zones, and plus disease (tortuosity and dilation of retinal blood vessels). In 2010 the annual incidence of blindness or visual impairment from ROP was estimated to affect 32,000 infants born preterm. All regions are now affected.

Risk factors for ROP include increasing prematurity, intrauterine fetal growth restriction and a range of postnatal risk factors including hyperoxia and fluctuating hypo-/hyperoxia, sepsis, failure to gain weight, thrombocytopenia and transfusion with blood products. Infants who are unstable, and who develop necrotising enterocolitis and bronchopulmonary dyplasia are particularly at risk.

Control of visual loss from ROP entails the following:

  • Reducing preterm birth rates;
  • A course of antenatal steroids to women threatening preterm delivery according to WHO indications and recommendations;
  • Gentle resuscitation of preterm newborns, such as delayed cord clamping and avoiding supplemental oxygen and ventilation unless necessary;
  • High quality neonatal care to reduce exposure to risk factors, with supportive care;
  • Regular screening of infants at risk, starting within a few weeks of birth, to detect those with the constellation signs of ROP where there is a significant risk of progression to blinding retinal detachment (i.e., 15% risk, described as Type 1 ROP);
  • Urgent treatment (within 48-72 hours) when indicated by a skilled ophthalmologist;
  • Long term follow up to detect and manage other conditions which are much more common in preterm infants who develop ROP, including high degrees of short-sightedness (high myopia), squint, and cortical vision impairment.

A range of professionals have important roles to play in reducing blindness or disability from ROP including obstetricians, gynaecologists and midwives; neonatologists, paediatricians and neonatal nurses, and ophthalmologists and optometrists. In addition, early vision rehabilitation can help overcome the developmental delay associated with profound vision loss of early onset.