Prematurity and Vision
Friday 3 March 2006
Retinopathy of Prematurity
Quality of Life
- 244 infants who had severe retinopathy of prematurity as newborns
- Families interviewed at age 10 years
- Health Utility Index
- 1=perfect health
- Sighted Median Score 0.87
- Blind/low vision Median score 0.27
- Blind/low vision 29% had a score < 0
- Uncontrolled oxygen in 1940s and 50s = epidemic of retrolental fibroplasia;
- Research in 1950s = low oxygen, low ROP, high mortality;
- Increased survival in 1980s = resurgence of ROP;
- Treatment ROP in 1990s
Current working understanding
- Early poor retinal blood vessel growth;
- Part of the retina ends up with no blood vessels;
- Increased demands of the growing retina;
- Abnormal blood vessel growth which leads to scar tissue;
- Scar tissue shrinks - Retinal detachment.
How are the infants examined?
How is treatment performed?
Looking to the future
- Can neonatologists prevent ROP?
- They think they can in Los Angeles!
- They have tried to in North East England
- Planned study of oxygen treatment
Causes of Visual Impairment in Children
- Cerebral Visual Impairment (CVI)
- Retinopathy of Prematurity
- Other diseases
Cerebral Visual Impairment - Context
- "Iatrogenic" – Often follows survival of infants who have received high quality neonatal care, who in other settings might have died.
- Hypoxic – Ischaemic Encephalopathy
- Prematurity (Incidence increasing)
- Brain Visual Impairment is associated with multiple handicap, unlike Eye Visual Impairment.
- Development and Education strategies DIFFERENT in BVI and EVI.
- Costs to society are x4 – x8 greater for BVI
- More likely to require long term financial and living support.
Cerebral Visual Impairment
- Hypoxic Ischaemic Encephalopathy (eg; "Birth Asphyxia")
- Cerebral Palsy of all 4 limbs
- Variable visual impairment
- Vision often improves during early years.
Cerebral Visual Impairment in Premature Infants
- Vision does NOT improve with time
- Crowding effects
- Difficulties with eye movements – nystagmus, strabismus
- MRI scan – Periventricular Leucomalacia (PVL)
- Pattern of injury DIFFERENT in premature than in full term infants.