The World Health Organization (WHO) is celebrating its World Innovation Day each year on November 17 to put the spotlight on premature babies.
Retinopathy of Prematurity (ROP) is a dynamic, time-bound disease that is not present at birth. The condition harms the eyes of early-stage infants, who usually receive intensive neonatal therapy (with or without oxygen therapy) that helps save their lives, but severely affects the development of the eye.
The condition is characterized by the development of abnormal blood vessels in the retina, resulting in scarring and retinal detachment. ROP can be easy and can be resolved spontaneously, but in severe cases, may progress quickly and lead to blindness.
ROP usually starts only two to three weeks after delivery, providing a window for screening and timely operation, while the baby is still in neonatal care.
ROP can, however, be treated by lasers if detected by proper retinal examination 30 days before birth. "Tis Din Roshani Ka" (Thirty Days to the Vision) should become the slogan used for all babies. The inability to have the first retinal screening done efficiently over time is a huge gap that needs to be addressed. A shortage of skilled personnel to provide effective bedside care for infants, especially who are still in strict care, and then the difficulties of follow-up are some of the gaps that must be addressed.
Chronic hypoxia (lack of oxygen), intrauterine growth retardation and prenatal and postpartum conditions are the most common causes of ROP. Infants under the age of 34 weeks and weight less than 2,000 grams are particularly sensitive to ROP and should be tested within 20-30 days of birth.
High levels of supplemental oxygen and high carbon dioxide level are also known to worsen ROP. During neonatal incubation, short term infants are being supplied with mixed oxygen, controlled solely in control using pulse oximeters. Other risk factors associated with the condition include anemia, bradycardia (low heart rate), blood transfusions and intraocular bleeding (brain bleeding).
The first incubators of pre-defined terms were established in Boston in 1941, and ROP's first blind child was immediately reported in medical journals in 1942. Since then there has been a tremendous amount of research and understanding about risk factors and successful management of this condition. Today we have great knowledge to prevent ROP blindness and have successfully done that for more than 90 percent of infants. While many babies are now receiving tests for ROP in time and are receiving treatment in many large and small cities of India, there are significant gaps and so there are still many ROP-blind vision infants affected today.
A very tight safety net should be placed where the baby has not yet maintained the potential vision he was born with. Gaps in this aspect can cause permanent damage and a lifetime of poor vision.
Common gaps include lack of ROP information between different teams of health care workers and parents on critical days; The medical curriculum of only a few super experts including ROP; Lack of skilled personnel to provide effective care for infants still in critical care, among others.
All children in the preterm range are at greater risk of developing other eye-related complications and vision later in life. Common conditions include retinal detachment, myopia, strabismus, amblyopia and glaucoma.
ROP is a possible reason to avoid usually irreversible blindness in infants in the short term. This disease has lifelong consequences for infected children and their families. Survival is achieved because of tremendous team effort by parents, extended family, doctors, nurses and health policy makers, apart from technological advances following well-prepared processes during the careful care of a newborn baby.
The World Health Organization (WHO) emphasized ROP as a major target for preventing blindness, Vision 2020: Right to Sight, to combat unnecessary blindness by 2020. On this day of the anniversary, all concerned should think not only about "survival" but Also their "vision".
(Dr. Subhadra Lali, director of the Department of Ophthalmology of the Newborn, L.V. Prasad Eye Institute Network, Hyderabad, the views expressed are personal).
Published for the first time: Nov. 17, 2018 14:00 IST