This document provides an overview of Retinopathy of Prematurity (ROP), which is a vascular disorder of the retina that occurs primarily in preterm infants. ROP can potentially lead to permanent blindness if not treated properly. The document discusses who is at risk for ROP, including preterm infants born before 34 weeks gestation or weighing less than 2kg. It outlines recommended screening guidelines to detect ROP, including screening all high-risk infants by one month of age. Timely screening and treatment can prevent blindness in most cases of ROP.
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Learning Objectives:
At the end of this lecture you should be able to know
- What is ROP?
- Why is ROP relevant for India?
- Who are at risk of ROP?
- When to screen for ROP and screening methods.
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Let’s start with a quiz…
• ROP is a disease of…
-cornea
- retina
- lens
• ROP occurs in…
- school children
- infants
- old persons
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• Potential impact of ROP on vision…
- no impact
- blindness
- mild blurring of vision
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• Definition - Vascular disorder of the retina
which occurs principally in the preterm infants.
• Specifically, occurs in the incompletely
vascularized retina.
• May lead to permanent blindness in a child.
Introduction
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Likely distribution of blindness in children due to retinopathy of prematurity using infant
mortality rates as an indicator. [Eye 2007 21: 1338−43].
Why do you think IMR can be a proxy indicator for estimating distribution of ROP blindness??
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Courtesy: Prof. Clare Gilbert, LSHTM, London
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Why should we care?
Poverty
relationship
s
Development
Isolation
Impact of Blindness*-
1. Kulkarni, S; Gilbert, C; Zuurmond, M ; Agashe S; Deshpande M. Blinding Retinopathy of Prematurity in Western India: Characteristics of Children, Reasons for Late Presentation and Impact on Families. 2018;55:665–70.
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Can you differentiate between ‘normal’ and ‘abnormal’?
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ROP : Who is at risk?
-Preterm (born < 34 weeks of pregnancy)
- low birth weight (< 2Kg ) infants
OR
- Bigger Infants (> 2kg) with critical illness during first
month after birth
Biggest baby treated by us- 2.4 kg BW
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Risk Factors:
• Prematurity - <34 weeks/ < 2kg
• ‘Unmonitored’ oxygen supply
• Infection (sepsis)
• Anemia requiring Blood transfusion
• Multiple births and many more…..
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ROP screening : Why?
• Premature babies are not born with the
disease
• ROP starts developing after 2-3 weeks of
birth.
• Blindness preventable with timely treatment
in most cases.
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ROP Screening - When
Govt of India guidelines 2017
• First screening: at or before Day 30 of life
• For extremely premature baby(<1200 gm/ <30 weeks): Day 20
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Screening: How?
Indirect Ophthalmoscopy
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Screening: How?
Imaging with a Digital Camera
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Do all preterm babies develop ROP?
• Less than half 20-44% (Indian reports)
• Sight threatening ROP: 3-10%
• Only sight threatening ROP requires laser treatment/
injections.
• Complications of ROP (retinal detachment) require surgery.
Good news: 90/100 preterm babies DO NOT develop blinding
ROP.
17. Stage 1 Stage 2 Stage 3
Stage 4 APROP
Post Laser stage 5
How does ROP look like?
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Is a preterm child free of risk once ROP is taken care of?
• No
• Other ocular diseases not uncommon in preterm*:
- High myopia
- Amblyopia, squint
- Cataract, glaucoma
- Delayed visual maturation
- Retinal detachment
1. Kulkarni Sucheta; Shah Mukti, Dole Kuldeep et al. Ocular Outcomes and Co-morbidities in preterm infants enrolled for Retinopathy of Prematurity screening: a Cohort study
from Western India. Oman J Ophthalmol. 2018;
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Need of follow up
• Every 3 months till 1 yr of age.
• Every 6 months thereafter till 3 yrs.
• Annual check up after 3 yrs.
Laser treated babies need lifelong follow up.
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What can we do to prevent ROP?
• Not possible in ALL cases but…
• Tight monitoring of oxygen supply
• Hand hygiene (prevent infection)
• Mother’s milk- weight gain, reduced infection
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KBC Time again……..
• Write your ‘code number’ on the top of a sheet of paper.
• Write your answers in front of question number.
(Example- Q 1- b, Q 3- a and so on)
• Exchange your answer sheet with your neighbor after
completion.
• Check your neighbor’s answers- One mark for each correct
answer.
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1. Blindness from ROP is preventable.
a. True
b. False
2. Birth weight cut off for ROP screening.
a. 1 kg
b. 2 kg
c. 2.5 kg
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3. What can a mother do to reduce risk of ROP in her child?
a. Oxygen monitoring
b. Observe eyes
c. breastfeeding
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4. What will you advise to a family of newborn preterm baby?
a. Ask your pediatrician about ROP screening.
b. Go to any ophthalmologist for ROP check up.
c. Go to a nearby PHC for screening.
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5. Your neighbor’s preterm child (BW 1.5 kg) is now 2 weeks old
and discharged from NICU. Parents were told about eye check up
but not told when? When would you advise them to get their
child’s ROP screening done?
At or before-
a. 3 months
b. 6 months
c. 1 month
Exchange your answer sheet with your neighbor and give 1 mark for each correct answer.