Every year, thousands of babies born prematurely face a battle not only for a steady heartbeat but also for clear eyesight. The risk of reVelisathy of prematurity (ROP)—a disorder affecting the developing retin could lead to complete blindness. Dr Girish Velis, consultant ophthalmologist (and ROP Specialist) from Healthway Hospitals provides a more profound understanding of the risks and the critical importance of early intervention.
Dr Girish Velis, consultant ophthalmologist and Vitreoretina surgeon
In the quiet intensity of neonatal intensive care units (NICUs) across Goa, a critical battle is fought every single day by newborns and doctors alike. It’s not just a struggle for breath or a steady heartbeat; it also entails a fight for the future sight of the most vulnerable infants.
While modern medicine has significantly increased the survival rates for “micro-preemies” (babies born before 28 weeks), it brings a secondary challenge: a rising incidence of ROP, or the Retinopathy of Prematurity – a serious risk to their vision. The disorder, if left undetected, can lead to permanent blindness. However, the tragedy is largely avoidable with timely intervention; Early detection means that its negative outcome is almost entirely preventable.
ROP is an eye disorder that affects the developing retina—the light-sensitive layer at the back of the eye. In a normal full term, the retina develops completely in the final weeks of pregnancy. However, premature birth hinders this growth and causes the blood vessels to form abnormally. These fragile vessels have a higher chance of leaking or scarring, and their growth eventually pulls the retina away from the eye wall (retinal detachment). This often leads to irreversible partial or total vision loss because the retina can no longer send signals to the brain.
ROP can generally affect babies who are born before 34 weeks, those who weigh less than 2,000 grams at birth and those who require prolonged oxygen therapy or face unstable health conditions.
While the vision loss itself is scary, the most dangerous aspect of ROP is that it is a disorder with no symptoms or early warning signs. The most common indicator is the ‘white reflex’, where the centre of the pupil appears white, grey or yellowish, instead of the normal red reflex (often seen in photos that used a flashlight).
However, by the time a parent notices this ‘white reflex’ in the eye or a poor visual response from the child, the disorder may already be advanced. Therefore, early eye check-ups are important, especially in case of prematurely born babies. In the world of ROP, a missed appointment can mean a lifetime of darkness.
Thus, the key to saving sight is simple: early screening. Every at-risk infant should have their first eye exam within the first four weeks of life. This exam is safe and can be performed right in the NICU. If ROP is detected early, it can be treated effectively through either laser therapy or anti-VEGF injections, which stops the growth of abnormal vessels. In more advanced cases, surgery followed by rehabilitation therapy is the last hope for some useful eyesight.
In order to detect ROP in its early stages, a team effort is an essential component of the prevention strategy. Neonatal teams must monitor oxygen carefully, while paediatricians must refer at-risk babies for eye screenings, and, most importantly, parents must stay vigilant with follow-up appointments after leaving the hospital.
The battle against ROP doesn’t end when the baby leaves the hospital. One of the greatest hurdles to the awareness of this disorder is the ‘lost to follow-up’ phenomenon new parents often face. This is understandable given that parents are often overwhelmed when they finally bring their baby home, and they might feel that a missed eye appointment is not much of a big deal because the baby seems fine.
But awareness is our most powerful tool. Every premature baby deserves the chance to see the world clearly, and by prioritising these simple check-ups, parents and doctors can protect countless children from a lifetime of visual disability.
Box 1
Who is at risk of developing ROP?
● Babies who are born before 34 weeks of gestation.
● Babies who weigh less than 2,000 grams at birth.
● Babies who require prolonged oxygen therapy or face unstable health conditions.
Box 2:
Treatment options available for ROP, if detected early
● Laser Therapy: To stop the growth of abnormal vessels.
● Anti-VEGF Injections: A modern medical advancement to manage vessel growth.
● Surgery: Required in more advanced cases.
(Dr Girish Velis, consultant opthalmologist at Healthway Hospitals, Goa)