Patient information: Retinopthy of Prematurity

What is the retina?  The retina lines the inside of the back of the eye.  It functions a bit like the film in the back of a camera, in that it absorbs light to form an image of the outside world.  The most important part of the retina is the macula - this is the part of the retina that the light is focussed on.  It gives the central vision that is important for fine visual tasks such as reading and driving.

What is retinopathy of prematurity?   Retinopathy of prematurity (ROP) occurs in prematurely born infants whose retina fails to develop normally.  An imbalance in the oxygen supply to the retina means that new blood vessels grow inside the eye.  These fragile new retinal vessels may bleed, or leak fluid that causes retinal scarring. In severe cases, the scarring can lead to retinal detachment, where the retina comes away from the back of the eye.  If this involves the macula, then the vision can be severely affected.  For this reason, infants born at less that 32 weeks old, or less than 1500 grams, are screened for ROP by an ophthalmologist (eye doctor). This screening occurs while the infant is in the hospital, shortly after birth.  Most infants who are screened do not develop ROP, but those that do are kept under close review.

How is retinopathy of prematurity treated? A minority of those with ROP develop progressive changes that can threaten the vision, and in this setting the ophthalmologist may recommend treatment. This is usually undertaken with a laser, or sometimes a freezing probe (cryoprobe).  Treatment is designed to reduce the oxygen needed by the eye, and thereby reduce the stimulus for new vessel growth and scarring of the retina.  In most cases the treatment is effective at stopping new vessel growth, and virtually all ophthalmologists feel that this type of treatment is worthwhile for those who need it.  In a small number of infants, despite the best possible treatment, the scarring process continues, and they develop more advanced disease.  Those with retinal detachment can be treated with surgery, but the outcome of surgery is not certain.  Some children may benefit, but not all, and surgery involves risks such as loss of vision, further surgery, worsening of the retinal detachment, glaucoma, and corneal problems.  For this reason, surgery for ROP is contentious. Some surgeons feel that the risks of surgery outweigh the benefits.  Other surgeons feel that, since there is no viable alternative, parents should have the option of surgery, as long as they understand the risks and that vision will not be normal.  Parents faced with the difficult decision of whether or not to allow their child to undergo  surgery for advanced ROP should not be afraid to ask questions; they  should be confident that they understand the issues before making up their mind.    As a retinal surgeon who feels that some children may benefit from surgery, I am happy to discuss these issues with parents.  I can also provide contact details for those who wish to seek a second opinion from a surgeon who does not feel surgery is worthwhile, so parents can hear both sides of the argument.

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