Retinopathy of Prematurity, and Richard Shapiro

From my good friend Richard Shapiro, information on a specific type of case he handles:

Retinopathy of Prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing approximately three pounds or less, born before 31 weeks of gestation (A full-term pregnancy has a gestation of 38–42 weeks). The smaller a baby is at birth, the more likely that baby will develop ROP. This condition is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness.

There is established medical proof that if ROP is treated timely (within 36-38 weeks of gestation or approximately at 6 weeks of age), it is likely that blindness will be prevented. Without proper care, the delay in diagnosis or treatment will often lead to permanent blindness.

What causes Retinopathy of Prematurity?

ROP occurs when abnormal blood vessels grow and spread throughout the retina, the tissue that lines the back of the eye. These abnormal blood vessels are fragile and can leak, scarring the retina and pulling it out of position. This causes a retinal detachment. Retinal detachment is the main cause of visual impairment and blindness in ROP.

Medical experts believe that the periphery of the retina sends out signals to other areas of the retina for nourishment. As a result, new abnormal vessels begin to grow. These new blood vessels are fragile, weak, and can bleed, leading to retinal scarring. When these scars shrink, they pull on the retina, causing it to detach from the back of the eye.

Most premature infants are either born/or treated at children’s hospitals or other pediatric hospital units within general hospitals.

How is ROP treated?

The most effective proven treatments for ROP are laser therapy or cryotherapy. Laser therapy "burns away" the periphery of the retina, which has no normal blood vessels. With cryotherapy, physicians use an instrument that generates freezing temperatures to briefly touch spots on the surface of the eye that overlie the periphery of the retina. Both laser treatment and cryotherapy destroy the peripheral areas of the retina, slowing or reversing the abnormal growth of blood vessels. Unfortunately, the treatments also destroy some side vision. This is done to save the most important part of our sight—the sharp, central vision we need for "straight ahead" activities such as reading, sewing, and driving.

Both laser treatments and cryotherapy are performed only on infants with advanced ROP, particularly stage III with "plus disease." Both treatments are considered invasive surgeries on the eye, and doctors don't know the long-term side effects of each.

In the later stages of ROP, other treatment options include:

* Scleral buckle. This involves placing a silicone band around the eye and tightening it. Infants who have had a sclera buckle need to have the band removed months or years later, since the eye continues to grow; otherwise they will become nearsighted. Sclera buckles are usually performed on infants with stage IV or V.

* Vitrectomy. Vitrectomy involves removing the vitreous and replacing it with a saline solution. After the vitreous has been removed, the scar tissue on the retina can be peeled back or cut away, allowing the retina to relax and lay back down against the eye wall. Vitrectomy is performed only at stage V.

Richard Shapiro may be reached here.