University of Edinburgh
 

Prematurity and Vision

Friday 3 March 2006

Retinopathy of Prematurity

Brian Fleck
Elizabeth Wright

premature baby

Quality of Life

  • 244 infants who had severe retinopathy of prematurity as newborns
  • Families interviewed at age 10 years
  • Health Utility Index
  • 0=dead
  • 1=perfect health
  • Sighted Median Score 0.87
  • Blind/low vision Median score 0.27
  • Blind/low vision 29% had a score < 0

eye pavilion edinburgh

History

  • 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.

retina

retinopathy

retina

How are the infants examined?

retinal scanner

scanning baby's eye

scanning baby's eye

normal retina

working with bay in incubator

How is treatment performed?

baby receiving treatment

two retinas in comparison

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.

brain scan side view

brain scan top view

diagram of vision

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.