Written by: Prof. Kent Caslo, Professional Director of ELIA, Developmental Optometrist.
ROP: Retinopathy of prematurity
Background (factor or factors)
Almost all eye development ends before birth, after birth there will be continued development that depends on the response to light. This process is especially true for the retina – the inner (back of the eye), is made up of receptor cells, which receive light and transmit an electrical message to the brain. The eye begins to develop at week 16 of pregnancy as blood vessels begin to develop in the center of the retina around the optic nerve. These blood vessels provide nutrition and oxygen to the developing retina and during pregnancy they grow to the area around the retina. This development is particularly rapid in the last 12 weeks of pregnancy.
In premature birth, there may be a halt in the development of blood vessels before they reach the circumference of the retina. So, a message is sent to the rest of the retina to grow new blood vessels. But these blood vessels (neo-vascularization) are fragile and tend to bleed, causing retinal scarring, retinal stretching and even retinal detachment. Therefore the damage of ROP can range from mild to most severe.
In addition to weight and time of birth, other risks for ROP are anemia, difficulty breathing and the general health condition of the preterm infant. In the modern age the dose of oxygen in the greenhouse is not considered a significant factor.
Medical treatment depends on the degree of ROP and requires partial destruction of the peripheral retina in order to maintain the central retina. The treatment is performed either by heat-laser or by cold-cryotherapy.
There are 5 degrees to the disease:
Grade 1: There are few irregular blood vessels. In most cases there is an improvement in vision with development and without treatment and normal vision is achieved.
Grade 2: There is a moderate amount of irregular blood vessels. In many cases, there is an improvement in vision without treatment and normal vision is achieved.
Grade 3: There is a significant amount of irregular and possibly large and ruptured blood vessels (Grade 3+). For some cases there is improvement without intervention and treatment, but if there are enlarged and excised blood vessels the rabbi will be given treatment to prevent retinal detachment.
Grade 4: There is a partial retinal detachment. There is retinal damage and the goal of treatment is to prevent further damage.
Grade 5: A state of complete retinal detachment (final state of the disease). Without treatment, there will be severe damage to vision until complete blindness.
Generally, the treatments described above will only be performed at grade 3+ and above.
Rehabilitation treatment will focus on vision functions – preserving and improving vision skills, addressing developmental challenges as a result of visual impairments including physiotherapy treatments, communication clinics, occupational therapy, required adjustments and work according to a personal rehabilitation program to maximize potential and promote the child according to his ability