RETINOPATHY OF PREMATURITY · RETINOPATHY OF PREMATURITY Renopathy of Prematurity (ROP) is a dynamic, me-bound disease that is not present at birth. The condion afflicts the eyes

NEWBORN CARE WEEK NOVEMBER 15-21

WORLD PREMATURITY DAY NOVEMBER 17

RETINOPATHYOFRETINOPATHYOFPREMATURITYPREMATURITY

RETINOPATHYOFPREMATURITY

PRETERMBABIESTOO,HAVETHERIGHTTOSIGHT

In the context of preven�ng

blindness in newborn babies,

Re�nopathyofPrematurity(ROP)

hasemergedasaseverechallenge

par�cularly in developing and

middle-incomegroupcountriesin

La�n America, Eastern Europe,

SouthEastAsia,ChinaandIndia.

ROP is a poten�ally avoidable

cause of irreversible and usually

totalblindnessinpretermbabies.

T h i s d i s e a s e h a s l i f e l o n g

implica�ons for afflicted children

andtheirfamilies.

India con�nues to lead with the

l a rge st n u m b e r o f v i s u a l l y

impaired and blind children,

globally.

Many countries like India are

expanding neonatal care but lack

sufficient knowledge, effec�ve

screening guidelines and bedside

programsforROP.

M o r e t h a n 6 0 % o f v i s u a l

i m p a i r m e nt s i n b a b i e s a re

preventableorcurablewith�mely

d e t e c � o n , p r o m p t a n d

appropr iate preven�ve and

cura�vemanagement.

The World Health Organiza�on

(WHO) has highlighted ROP as a

major target d i sease in i t s

preven�on of blindness program,

“VISION 2020: Right to Sight” to

combat need less b l indness

globallybytheyear2020.

Theprogramtargetsallbabiesat

risk for ROP, for screening eye

examina�ons and access to

treatmentforsevereROP.

02 03

PRETERMBABIESTOO,HAVETHERIGHTTOSIGHT

In the context of preven�ng

blindness in newborn babies,

Re�nopathyofPrematurity(ROP)

hasemergedasaseverechallenge

par�cularly in developing and

middle-incomegroupcountriesin

La�n America, Eastern Europe,

SouthEastAsia,ChinaandIndia.

ROP is a poten�ally avoidable

cause of irreversible and usually

totalblindnessinpretermbabies.

T h i s d i s e a s e h a s l i f e l o n g

implica�ons for afflicted children

andtheirfamilies.

India con�nues to lead with the

l a rge st n u m b e r o f v i s u a l l y

impaired and blind children,

globally.

Many countries like India are

expanding neonatal care but lack

sufficient knowledge, effec�ve

screening guidelines and bedside

programsforROP.

M o r e t h a n 6 0 % o f v i s u a l

i m p a i r m e nt s i n b a b i e s a re

preventableorcurablewith�mely

d e t e c � o n , p r o m p t a n d

appropr iate preven�ve and

cura�vemanagement.

The World Health Organiza�on

(WHO) has highlighted ROP as a

major target d i sease in i t s

preven�on of blindness program,

“VISION 2020: Right to Sight” to

combat need less b l indness

globallybytheyear2020.

Theprogramtargetsallbabiesat

risk for ROP, for screening eye

examina�ons and access to

treatmentforsevereROP.

02 03

RETINOPATHYOFPREMATURITY

Re�nopathyofPrematurity(ROP)

isadynamic,�me-bounddisease

thatisnotpresentatbirth.

The condi�on afflicts the eyes of

pretermbabiesthathavetypically

received hospital based neonatal

care (with or without oxygen

therapy) that helps to save their

life,butseverelyaffectstheireye

development.

Thecondi�on is characterizedby

development of abnormal blood

vessels in the re�na of the eye,

resul�ng in scarring and re�nal

detachment.

ROPcanbemildandmayresolve

spontaneously, but in serious

cases, may progress rapidly and

leadtoblindness.

ROPtypicallystartsonly2-3weeks

a�er birth, providing a window

periodforscreeningandini�a�ng

treatmentattheright�me,while

the baby is s�ll under neonatal

careatthehospital.

04 05

RETINOPATHYOFPREMATURITY

Re�nopathyofPrematurity(ROP)

isadynamic,�me-bounddisease

thatisnotpresentatbirth.

The condi�on afflicts the eyes of

pretermbabiesthathavetypically

received hospital based neonatal

care (with or without oxygen

therapy) that helps to save their

life,butseverelyaffectstheireye

development.

Thecondi�on is characterizedby

development of abnormal blood

vessels in the re�na of the eye,

resul�ng in scarring and re�nal

detachment.

ROPcanbemildandmayresolve

spontaneously, but in serious

cases, may progress rapidly and

leadtoblindness.

ROPtypicallystartsonly2-3weeks

a�er birth, providing a window

periodforscreeningandini�a�ng

treatmentattheright�me,while

the baby is s�ll under neonatal

careatthehospital.

04 05

40CRITICALWEEKS

Thelasttwelveweeksofanormal

term gesta�on are crucial in the

developmentoffetaleyes.

The fetal re�na (�ssue that lines

the back of the eye) slowly

maturesinthemother'swombby

40weeks,whichisbytheexpected

dateofdelivery.

From 16 weeks to birth, re�nal

blood vessels grow out from the

op�cnervetoreachtheperipheral

re�na.

In preterm babies, the normal

growthofbloodvesselsstops.The

area without adequate blood

supplyemitsachemicaltriggerto

s�mulate growth of abnormal

vessels.

Theseabnormalbloodvesselsare

fragileandcan leadto forma�on

of a ring of scar �ssue that is

a�ached to both the re�na and

thevitreousgelthatfillsthecenter

oftheeyes.

Asthescar�ssuecontracts,itmay

pull the re�na out of posi�on,

crea�ngare�naldetachment.

Re�nal detachment is the prime

cause of visual impairment and

blindnessinROP.

06 07

40CRITICALWEEKS

Thelasttwelveweeksofanormal

term gesta�on are crucial in the

developmentoffetaleyes.

The fetal re�na (�ssue that lines

the back of the eye) slowly

maturesinthemother'swombby

40weeks,whichisbytheexpected

dateofdelivery.

From 16 weeks to birth, re�nal

blood vessels grow out from the

op�cnervetoreachtheperipheral

re�na.

In preterm babies, the normal

growthofbloodvesselsstops.The

area without adequate blood

supplyemitsachemicaltriggerto

s�mulate growth of abnormal

vessels.

Theseabnormalbloodvesselsare

fragileandcan leadto forma�on

of a ring of scar �ssue that is

a�ached to both the re�na and

thevitreousgelthatfillsthecenter

oftheeyes.

Asthescar�ssuecontracts,itmay

pull the re�na out of posi�on,

crea�ngare�naldetachment.

Re�nal detachment is the prime

cause of visual impairment and

blindnessinROP.

06 07

*TEESDINROSHNIKE !

Chronic hypoxia (lack of oxygen),

intrauterine growth retarda�on

and prenatal and postnatal

condi�onsarethemostcommon

triggersofROP.

Babies born under 34 weeksgesta�on and weighing less than2000 grams are par�cularlysuscep�ble to ROP and must bescreened within 20-30 days frombirth.

High levels of supplementaloxygen and high carbon dioxidelevelsarealsoknowntoaggravateROP.Duringneonatal incuba�on,pretermbabiesaretobeprovided

with blended oxygen, strictlycontrolled and monitored usingpulseoxymeters.

Other r i sk factors that areassociated with the condi�onincludeanemia,bradycardia (lowheartrate),bloodtransfusionsandintraven�cular hemorrhage(bleedingintothebrain).

Addi�onally, prenatal maternalfactorscompoundtheprobabilityof an ROP occurrence. Theseinclude infer�lity treatments,twinsandtriplets,heavysmoking,a n e m i a , d i a b e t e s a n dpreeclampsia.

*Thirtydaystovision!

08 09

*TEESDINROSHNIKE !

Chronic hypoxia (lack of oxygen),

intrauterine growth retarda�on

and prenatal and postnatal

condi�onsarethemostcommon

triggersofROP.

Babies born under 34 weeksgesta�on and weighing less than2000 grams are par�cularlysuscep�ble to ROP and must bescreened within 20-30 days frombirth.

High levels of supplementaloxygen and high carbon dioxidelevelsarealsoknowntoaggravateROP.Duringneonatal incuba�on,pretermbabiesaretobeprovided

with blended oxygen, strictlycontrolled and monitored usingpulseoxymeters.

Other r i sk factors that areassociated with the condi�onincludeanemia,bradycardia (lowheartrate),bloodtransfusionsandintraven�cular hemorrhage(bleedingintothebrain).

Addi�onally, prenatal maternalfactorscompoundtheprobabilityof an ROP occurrence. Theseinclude infer�lity treatments,twinsandtriplets,heavysmoking,a n e m i a , d i a b e t e s a n dpreeclampsia.

*Thirtydaystovision!

08 09

Newborncareunit:NearlyeverypretermbabyherewouldbeathighriskforROP.

BORNTOOSOON

E a r l y s t a g e s o f R O P, w h e r etreatment is effec�ve, have nosymptomsandtheeyelooksnormalfromtheoutside.

Hence, rou�ne re�nal screeningwithin3-4weeksofbirthistheonlyway to detect vision-threateningstagesofROP.

Preterm babies born at 23-27weeks should be examinedwithinthreeweeksofbirth.

Preterm babies born at orbeyond 28 weeks should beexaminedbythefourthweek,byDay-30oflife.

P reterm babies should beexaminedpriortodischargefromthe hospital if they are likely tomissafollow-upexamina�on.

During this period, most pretermbabiesareincri�calcareando�enincubatedinNeonatalIntensiveCareUnits (NICU) and Special NewbornCareUnits(SNCU).

Aneyespecialistmustbeappointedat the neonatal care hospital, toexamine the re�na of newborns.Caregiversneedtobegeareduptoc o n d u c t R O P s c re e n i n g a n dt r e a t m e n t i n s u c h a d v e r s esitua�ons.

For posi�ve outcomes, treatmentwithlaserphotocoagula�onmustbecarried out within 72 hours of

detec�onofthecondi�on.

F o l l o w - u p s c r e e n i n g a sr e c o m m e n d e d a � e r i n i � a lexamina�on must be st r ic t lyfollowedtoavoidirreversiblevisionloss.

Allpretermchildrenrunahigherriskindevelopingothereyeandvision-related complica�ons later in theirlives.

EvenpretermchildrenwithoutROPcondi�on are likely to developsquint, lazy eyes (amblyopia) andsignificant refrac�ve problems thatrequireprescrip�oneyeglasses.

Thus, bi-annual eye examina�onsare recommended for all pretermbabies born under 34 weeks orweighinglessthan2000grams.

The most effec�ve preven�on ofROPisthepreven�onofprematurebirththatiscurrentlynotpossible.Infactthese instancesareontherisepar�allyduetoassistedfer�liza�ontechniques that o�en result inprematureandmul�plebirths.

Preven�ng other complica�ons ofprematurity (such as neonatalrespiratory distress syndrome) mayalso help prevent ROP. Antenatalsteroids administered to high-riskmothers are one of the op�onsavailable.

10 11

Newborncareunit:NearlyeverypretermbabyherewouldbeathighriskforROP.

BORNTOOSOON

E a r l y s t a g e s o f R O P, w h e r etreatment is effec�ve, have nosymptomsandtheeyelooksnormalfromtheoutside.

Hence, rou�ne re�nal screeningwithin3-4weeksofbirthistheonlyway to detect vision-threateningstagesofROP.

Preterm babies born at 23-27weeks should be examinedwithinthreeweeksofbirth.

Preterm babies born at orbeyond 28 weeks should beexaminedbythefourthweek,byDay-30oflife.

P reterm babies should beexaminedpriortodischargefromthe hospital if they are likely tomissafollow-upexamina�on.

During this period, most pretermbabiesareincri�calcareando�enincubatedinNeonatalIntensiveCareUnits (NICU) and Special NewbornCareUnits(SNCU).

Aneyespecialistmustbeappointedat the neonatal care hospital, toexamine the re�na of newborns.Caregiversneedtobegeareduptoc o n d u c t R O P s c re e n i n g a n dt r e a t m e n t i n s u c h a d v e r s esitua�ons.

For posi�ve outcomes, treatmentwithlaserphotocoagula�onmustbecarried out within 72 hours of

detec�onofthecondi�on.

F o l l o w - u p s c r e e n i n g a sr e c o m m e n d e d a � e r i n i � a lexamina�on must be st r ic t lyfollowedtoavoidirreversiblevisionloss.

Allpretermchildrenrunahigherriskindevelopingothereyeandvision-related complica�ons later in theirlives.

EvenpretermchildrenwithoutROPcondi�on are likely to developsquint, lazy eyes (amblyopia) andsignificant refrac�ve problems thatrequireprescrip�oneyeglasses.

Thus, bi-annual eye examina�onsare recommended for all pretermbabies born under 34 weeks orweighinglessthan2000grams.

The most effec�ve preven�on ofROPisthepreven�onofprematurebirththatiscurrentlynotpossible.Infactthese instancesareontherisepar�allyduetoassistedfer�liza�ontechniques that o�en result inprematureandmul�plebirths.

Preven�ng other complica�ons ofprematurity (such as neonatalrespiratory distress syndrome) mayalso help prevent ROP. Antenatalsteroids administered to high-riskmothers are one of the op�onsavailable.

10 11

NATIONAL ROP TASK FORCE (2014 - TILL DATE)

Chair: 1) Smt Vandana Gurnani, Joint Secretary (RMNCH+A), Ministry of Health and Family Welfare

2) Dr R Azad , Ophthalmology expert, Ex Director, Dr R.P. Centre forOphthalmic Sciences, All India Institute for Medical Sciences (AIIMS), New Delhi

Members:� Prof Ashok Deorari, Professor, Paediatrics, AIIMS, New Delhi � Dr Ramesh Agarwal, Neonatologist, AIIMS, New Delhi � Dr Praveen Vashist, Additional Professor and Head, Community

� Dr N K Agarwal, Deputy Director General (O), National Programme

� Dr Gagan Gupta, Country Director, United Nations International

� Dr Shikar Jain, President, National Neonatology Forum of India � Dr Hema Diwakar, Representative, Federation of Obsterics and

Gynaecological Societies of India

� Dr Manju Vatsa, President, India Association of Newborn Nursing � Dr GVS Murthy, Principal Investigator, Director-Public Health Foundation

of India, Hyderabad

� Dr Rajan Shukla, Co-investigator, Public Health Foundation of India,Hyderabad

� Dr Sara Varughese, President, VISION 2020 India� Prof Clare Gilbert, Principal Investigator, London School of Hygiene and

Tropical Medicine (Advisor to The Queen Elizabeth Diamond Jubilee Trust)

� Dr P K Prabhakar, Deputy Commissioner (Child Health), Ministry of Health and Family Welfare

� Dr Arun Singh, National Advisor (RBSK), Ministry of Health and FamilyWelfare

� Dr Renu Srivastava, SNCU Coordinator, Ministry of Health & Family Welfare

Ministry of Health and Family Welfare

12

Opthalmology, Dr. R.P.Centre for Ophthalmic Sciences, AIIMS

for Control of Blindness (NPCB)

Children’s Fund

NATIONALROPTASKFORCE(2014-TILLDATE)

Chair:DrRakeshKumar,JointSecretary(RMNCH+A),MinistryofHealth

andFamilyWelfareCo-chair: Professor Y R Sharma, AIIMS Ophthalmologist, Co-Program

Director,AIIMS,NewDelhi

Members: ProfAshokDeorari,AIIMSNeonatologist,Co-ProgramDirector DrRameshAgarwal,AIIMSNeonatologist DrPraveenVashist,AIIMS,CommunityOpthalmology ProfRVAzad,AIIMS,PrincipalAdvisor,Opthalmology DrNKAgarwal,NPCB,DeputyDirectorGeneral(o),DGHS DrGaganGupta,UNICEFCountryDirector DrShikarJain,NNFPresidentorRepresenta�ve DrHemaDiwakar,FOGSIPresidentorRepresenta�ve DrManjuVatsa,IndiaAssocia�onOfNewbornNursing,President DrGVSMurthy,PHFIrepresenta�ve,ProgrammeManager DrRajanShukla,PHFIrepresenta�ve,TechnicalAdvisor DrSaraVarughese,VISION2020India,President Prof Clare Gilbert, The Queen Elizabeth Diamond Jubilee Trust,

Representa�ve DrPKPrabhakar,DeputyCommissioner (ChildHealth),Ministryof

Health&FamilyWelfare DrArunSingh,Na�onalAdvisor(RBSK),MinistryofHealth&Family

Welfare DrRenuSrivastava, SNCUCoordinator,MinistryofHealth&Family

Welfare

MinistryofHealthandFamilyWelfare ExpertWorkingGroup

(a)NeonatologyFaculty

DrPraveenKumar,PGIMER,Chandigarh DrDeepakChawla,GMCH,Chandigarh DrSrinivasMurki,FernandezHospital,Hyderabad DrVenkatSeshan,PGIMER,Chandigarh

(b)ROPProgramFaculty

DrParijatChandra,AIIMS,NewDelhi DrSubhadraJalali,LVPEI,Hyderabad DrMangatDogra,PGIMER,Chandigarh DrVNarendran,AravindEyeHospital,Coimbatore DrPramodBhende,SankaraNethralaya,Chennai DrAnandVinekar,NarayanaNethralaya,Bangalore

Convener:DrAjayKhera,DeputyCommissioner-in-charge(ChildHealth

andImmuniza�on),MinistryofHealth&FamilyWelfare

12 13

NATIONALANNUALROPSCENARIOINRECENTYEARS

HOSPITALSININDIAGEARINGUPTOHANDLECOMPLICATEDROPCASES

Note: DatacollectedfromindividualeyehospitalsacrossIndia SurgeriesperformedincludeLaser,VitrectomiesandAn�VEGFinjec�ons

Ateamofophthalmologistsveryrecentlywerechallengedtoperformadifficultsurgerya�nybaby,just6weeksoldandnotgainingweight,sufferingfrom a cri�cal, poten�ally blinding condi�on - Re�nopathy of Prematurity(ROP).Itcouldhavepermanentlydestroyedthere�naofboththeeyesifnotoperatedwithin3days!

Whentheparentsofthatfragilebabycametothehospitalforthefirst�me,theyweredoub�ulwhetheranIndianhospitalwillbeequippedtohandlesuchadelicateandchallengingcase.Theparentsweretoldthatanemergencyopera�onwasrequired;risksandbenefitswereclearlylaidout.The low weight of the baby was a challenge for the team ofophthalmologists, anesthe�sts, nursing staff, counsellors, and theneonatologistduetoaveryhighriskofanesthesia-relatedcomplica�ons,eveninthebestofcentres.Theparentsfinallyconsentedtothesurgery,reassuredbythegenuineconcernofthedoctorsfortheirchild’svisionandlife.

Anemergencycoreteamwascons�tuted.Notonlypremature,thebabywasanaemicandsufferingfrompoornutri�on.Counsellorscoordinatedwith the baby’s neonatologist and the parents for all the preopera�veevalua�onandpaperwork,without�ringthis�nylife.

Allprepara�onsweremadewithin48hourstomakethebabyasfitaspossibleforsafeanesthesia.Bloodtransfusion,lungs,liverfunc�on,kidneyfunc�on,nutri�onandelectrolytebalance,cardiaccare–somuchtobeassessedandmanagedatsuchshortno�ce!Thebabywasbroughttothetheatre and a highly competent neonatal anesthesiologist, played thepivotalrole,supportedbyseniorcolleagueandtheanesthesiatechnician.

Anaccomplishedre�nalsurgeon,operateduponboththebaby'seyesusingmicrosurgicaltechniques.Opera�nguponaneyelessthan16mminsize,without causingdamage tocri�cal structures like the lensand there�na,requiredsurgicalprecision,dexterityandapassionforperfec�on.Whenthebabys�rredoutofanesthesiaandcried,thewholeteamandtheanxiousadministrators,counsellorsandparentsoutside,knewthattheyhadallcollec�velyasateamsucceededinsavingtheeyesightofthebaby.Lessthanamonthlater,thehealthyandhappybabyspreadsunshineonareturnvisit,asshesmiledatthedoctor,lookingupwithpre�ygoodvisioninbothherbrighteyes!

HospitalsinIndiaarenowsuccessfullyhandlingROPcasesandarealsotrea�ngpa�entsfromneighboringcountries.

16 17

NATIONALANNUALROPSCENARIOINRECENTYEARS

HOSPITALSININDIAGEARINGUPTOHANDLECOMPLICATEDROPCASES

Note: DatacollectedfromindividualeyehospitalsacrossIndia SurgeriesperformedincludeLaser,VitrectomiesandAn�VEGFinjec�ons

Ateamofophthalmologistsveryrecentlywerechallengedtoperformadifficultsurgerya�nybaby,just6weeksoldandnotgainingweight,sufferingfrom a cri�cal, poten�ally blinding condi�on - Re�nopathy of Prematurity(ROP).Itcouldhavepermanentlydestroyedthere�naofboththeeyesifnotoperatedwithin3days!

Whentheparentsofthatfragilebabycametothehospitalforthefirst�me,theyweredoub�ulwhetheranIndianhospitalwillbeequippedtohandlesuchadelicateandchallengingcase.Theparentsweretoldthatanemergencyopera�onwasrequired;risksandbenefitswereclearlylaidout.The low weight of the baby was a challenge for the team ofophthalmologists, anesthe�sts, nursing staff, counsellors, and theneonatologistduetoaveryhighriskofanesthesia-relatedcomplica�ons,eveninthebestofcentres.Theparentsfinallyconsentedtothesurgery,reassuredbythegenuineconcernofthedoctorsfortheirchild’svisionandlife.

Anemergencycoreteamwascons�tuted.Notonlypremature,thebabywasanaemicandsufferingfrompoornutri�on.Counsellorscoordinatedwith the baby’s neonatologist and the parents for all the preopera�veevalua�onandpaperwork,without�ringthis�nylife.

Allprepara�onsweremadewithin48hourstomakethebabyasfitaspossibleforsafeanesthesia.Bloodtransfusion,lungs,liverfunc�on,kidneyfunc�on,nutri�onandelectrolytebalance,cardiaccare–somuchtobeassessedandmanagedatsuchshortno�ce!Thebabywasbroughttothetheatre and a highly competent neonatal anesthesiologist, played thepivotalrole,supportedbyseniorcolleagueandtheanesthesiatechnician.

Anaccomplishedre�nalsurgeon,operateduponboththebaby'seyesusingmicrosurgicaltechniques.Opera�nguponaneyelessthan16mminsize,without causingdamage tocri�cal structures like the lensand there�na,requiredsurgicalprecision,dexterityandapassionforperfec�on.Whenthebabys�rredoutofanesthesiaandcried,thewholeteamandtheanxiousadministrators,counsellorsandparentsoutside,knewthattheyhadallcollec�velyasateamsucceededinsavingtheeyesightofthebaby.Lessthanamonthlater,thehealthyandhappybabyspreadsunshineonareturnvisit,asshesmiledatthedoctor,lookingupwithpre�ygoodvisioninbothherbrighteyes!

HospitalsinIndiaarenowsuccessfullyhandlingROPcasesandarealsotrea�ngpa�entsfromneighboringcountries.

16 17

18 19

FIVESTAGES

ROPmanifestsitselfinfivestages

that require varied courses of

managementandtreatment.

Stage-IThere is mild abnormal blood

vesselgrowththat requiresclose

periodicexamina�on,butmaynot

needanytreatment.

Stage-IIBloodvesselgrowthismoderately

abnormalandinsomecasesmay

needearlytreatment.

Stage-I and most Stage-II do not

leadtoblindness.Howeverifnot

monitored, they can progress to

moreseverestages.

Stage-IIIBlood vessel growth is severely

abnormal and the newborn

requiresearlytreatmentwithin72

hoursasthisisvisionthreatening.

Stage-IVBlood vessel growth is severely

abnormal and there is a par�ally

detached re�na. Urgent surgical

treatment is recommended to

diminish the chances of loss of

vision.

Stage-VThereisatotalre�naldetachment

andonlyveryfeweyesgetminimal

v is ion even a�er advanced

surgicaltreatment.

18 19

FIVESTAGES

ROPmanifestsitselfinfivestages

that require varied courses of

managementandtreatment.

Stage-IThere is mild abnormal blood

vesselgrowththat requiresclose

periodicexamina�on,butmaynot

needanytreatment.

Stage-IIBloodvesselgrowthismoderately

abnormalandinsomecasesmay

needearlytreatment.

Stage-I and most Stage-II do not

leadtoblindness.Howeverifnot

monitored, they can progress to

moreseverestages.

Stage-IIIBlood vessel growth is severely

abnormal and the newborn

requiresearlytreatmentwithin72

hoursasthisisvisionthreatening.

Stage-IVBlood vessel growth is severely

abnormal and there is a par�ally

detached re�na. Urgent surgical

treatment is recommended to

diminish the chances of loss of

vision.

Stage-VThereisatotalre�naldetachment

andonlyveryfeweyesgetminimal

v is ion even a�er advanced

surgicaltreatment.

1)Bornat28weeks1)Bornat28weeks1)Bornat28weeks

4)Re�nahasdetachedasscreeningwasnotdone4)Re�nahasdetachedasscreeningwasnotdonewithin30days&nolasertreatmentwasgivenwithin30days&nolasertreatmentwasgiven4)Re�nahasdetachedasscreeningwasnotdonewithin30days&nolasertreatmentwasgiven

3)Onscreening,treatableROPisdetected3)Onscreening,treatableROPisdetectedin15-20%babies.Immediatelaserin15-20%babies.Immediatelasertreatmentcancurethisbleedingtreatmentcancurethisbleeding

3)Onscreening,treatableROPisdetectedin15-20%babies.Immediatelasertreatmentcancurethisbleeding

2)Screeningdonewithin30daysofbirthto2)Screeningdonewithin30daysofbirthtoprotectvisionprotectvision2)Screeningdonewithin30daysofbirthtoprotectvision

6)LostvisionduetonoROPScreening6)LostvisionduetonoROPScreeningandverylatedetec�onandverylatedetec�on6)LostvisionduetonoROPScreeningandverylatedetec�on

5)Timelyinterven�onsavedhervision5)Timelyinterven�onsavedhervision5)Timelyinterven�onsavedhervision

20 21

ROPdevelops2-3weeksa�erbirthduetoprematurityandlowweight;and then worsens due to manyfactors.

If detected by a comprehensivere�nal examina�on within 20-30days from birth, ROP can becontrolledandmanagedthroughavarietyoftreatments.

LaserTherapyorPhotocoagula�onis themost common typeof ROPsurgeryinwhichsmalllaserbeamsare used to treat the peripheralre�naandstoptheprogression.

Cryotherapy deploys freezingtemperaturestoscartheperipheralre�na.

LaserTherapyandCryotherapyareonly performed on babies withadvancedROP,par�cularlyStage-IIwith 'plus disease' and Stage-IIIdisease.

Research studies are currentlybeing conducted for newer andevolved treatments using an�-VEGF injec�ons in the eye, as asupplement or subs�tute to lasertherapy.

For advanced stages of ROP,

treatment op�ons include ScleralBuckleandVitrectomy.

S c l e ra l B u c k l e s a re u s u a l l yperformedonbabiesinROPStage-IV.

Thisinvolvesplacingasiliconebandaround the eye and �ghtening it.This keeps the vitreous gel frompullingonthescar�ssueandallowsthe re�na to fla�en back downontothewalloftheeye.

Babies who have had a ScleralBuckle need to have the bandreleased months or even yearslater, since the eye con�nues togrow;otherwisetheywillbecomenearsighted.

Vitrectomy is performed foradvancedROPatStages-IVandV.

Thisinvolvesremovingthevitreousand replacing it with a salinesolu�on.

A�er the v i treous has beenremoved, the scar �ssue on there�na can be peeled back or cutaway, allowing the re�na to relaxandlaybackdownagainsttheeyewall.

BACKFROMTHEBRINK

1)Bornat28weeks1)Bornat28weeks1)Bornat28weeks

4)Re�nahasdetachedasscreeningwasnotdone4)Re�nahasdetachedasscreeningwasnotdonewithin30days&nolasertreatmentwasgivenwithin30days&nolasertreatmentwasgiven4)Re�nahasdetachedasscreeningwasnotdonewithin30days&nolasertreatmentwasgiven

3)Onscreening,treatableROPisdetected3)Onscreening,treatableROPisdetectedin15-20%babies.Immediatelaserin15-20%babies.Immediatelasertreatmentcancurethisbleedingtreatmentcancurethisbleeding

3)Onscreening,treatableROPisdetectedin15-20%babies.Immediatelasertreatmentcancurethisbleeding

2)Screeningdonewithin30daysofbirthto2)Screeningdonewithin30daysofbirthtoprotectvisionprotectvision2)Screeningdonewithin30daysofbirthtoprotectvision

6)LostvisionduetonoROPScreening6)LostvisionduetonoROPScreeningandverylatedetec�onandverylatedetec�on6)LostvisionduetonoROPScreeningandverylatedetec�on

5)Timelyinterven�onsavedhervision5)Timelyinterven�onsavedhervision5)Timelyinterven�onsavedhervision

20 21

ROPdevelops2-3weeksa�erbirthduetoprematurityandlowweight;and then worsens due to manyfactors.

If detected by a comprehensivere�nal examina�on within 20-30days from birth, ROP can becontrolledandmanagedthroughavarietyoftreatments.

LaserTherapyorPhotocoagula�onis themost common typeof ROPsurgeryinwhichsmalllaserbeamsare used to treat the peripheralre�naandstoptheprogression.

Cryotherapy deploys freezingtemperaturestoscartheperipheralre�na.

LaserTherapyandCryotherapyareonly performed on babies withadvancedROP,par�cularlyStage-IIwith 'plus disease' and Stage-IIIdisease.

Research studies are currentlybeing conducted for newer andevolved treatments using an�-VEGF injec�ons in the eye, as asupplement or subs�tute to lasertherapy.

For advanced stages of ROP,

treatment op�ons include ScleralBuckleandVitrectomy.

S c l e ra l B u c k l e s a re u s u a l l yperformedonbabiesinROPStage-IV.

Thisinvolvesplacingasiliconebandaround the eye and �ghtening it.This keeps the vitreous gel frompullingonthescar�ssueandallowsthe re�na to fla�en back downontothewalloftheeye.

Babies who have had a ScleralBuckle need to have the bandreleased months or even yearslater, since the eye con�nues togrow;otherwisetheywillbecomenearsighted.

Vitrectomy is performed foradvancedROPatStages-IVandV.

Thisinvolvesremovingthevitreousand replacing it with a salinesolu�on.

A�er the v i treous has beenremoved, the scar �ssue on there�na can be peeled back or cutaway, allowing the re�na to relaxandlaybackdownagainsttheeyewall.

BACKFROMTHEBRINK

22 23

FUTURECONCERNS

All preterm children run a higher risk in theAll preterm children run a higher risk in the

development of eye and vision-relateddevelopment of eye and vision-related

complica�onsotherthanROPlaterintheirlives.complica�onsotherthanROPlaterintheirlives.

Commonafflic�onsincludere�naldetachment,Commonafflic�onsincludere�naldetachment,

myopia(near-sightedness),strabismus(crossedmyopia(near-sightedness),strabismus(crossed

eyes),amblyopia(lazyeye)andglaucoma.eyes),amblyopia(lazyeye)andglaucoma.

Inmostcases,thesecondi�onscanbetreatedorInmostcases,thesecondi�onscanbetreatedor

controlled.controlled.

Bi-annual eye examina�ons are recommendedBi-annual eye examina�ons are recommended

forallpretermbabiesbornunder34weeksorforforallpretermbabiesbornunder34weeksorfor

thosethatweighlessthan2000grams.thosethatweighlessthan2000grams.

All preterm children run a higher risk in the

development of eye and vision-related

complica�onsotherthanROPlaterintheirlives.

Commonafflic�onsincludere�naldetachment,

myopia(near-sightedness),strabismus(crossed

eyes),amblyopia(lazyeye)andglaucoma.

Inmostcases,thesecondi�onscanbetreatedor

controlled.

Bi-annual eye examina�ons are recommended

forallpretermbabiesbornunder34weeksorfor

thosethatweighlessthan2000grams.

22 23

FUTURECONCERNS

All preterm children run a higher risk in theAll preterm children run a higher risk in the

development of eye and vision-relateddevelopment of eye and vision-related

complica�onsotherthanROPlaterintheirlives.complica�onsotherthanROPlaterintheirlives.

Commonafflic�onsincludere�naldetachment,Commonafflic�onsincludere�naldetachment,

myopia(near-sightedness),strabismus(crossedmyopia(near-sightedness),strabismus(crossed

eyes),amblyopia(lazyeye)andglaucoma.eyes),amblyopia(lazyeye)andglaucoma.

Inmostcases,thesecondi�onscanbetreatedorInmostcases,thesecondi�onscanbetreatedor

controlled.controlled.

Bi-annual eye examina�ons are recommendedBi-annual eye examina�ons are recommended

forallpretermbabiesbornunder34weeksorforforallpretermbabiesbornunder34weeksorfor

thosethatweighlessthan2000grams.thosethatweighlessthan2000grams.

All preterm children run a higher risk in the

development of eye and vision-related

complica�onsotherthanROPlaterintheirlives.

Commonafflic�onsincludere�naldetachment,

myopia(near-sightedness),strabismus(crossed

eyes),amblyopia(lazyeye)andglaucoma.

Inmostcases,thesecondi�onscanbetreatedor

controlled.

Bi-annual eye examina�ons are recommended

forallpretermbabiesbornunder34weeksorfor

thosethatweighlessthan2000grams.

ROPisanincreasingconcernamongstyoungparents.

Although medical innova�ons in ROP treatment have

decreasedtheprobabilityoflossofvision,unfortunatelyit

doesnotalwayspreventit.

If an infant does not respond to ROP treatment, the

diseasemayprogress,whereinare�naldetachmentcould

develop.

O�en,thisisa'Stage-IV'manifesta�oninwhichonlyapart

ofthere�nadetachesandmayneedurgentsurgery.

InaStage-Vpa�ent,thecentreofthere�naortheen�re

re�nadetaches.Centralvisionisthreatenedandsurgeryis

o�en recommended to rea�ach the re�na. However,

results are o�en not favorable, with most children

remainingpermanentlyblind.

BATTLINGAGAINSTTHEODDS

ROPisanincreasingconcernamongstyoungparents.

Although medical innova�ons in ROP treatment have

decreasedtheprobabilityoflossofvision,unfortunatelyit

doesnotalwayspreventit.

If an infant does not respond to ROP treatment, the

diseasemayprogress,whereinare�naldetachmentcould

develop.

O�en,thisisa'Stage-IV'manifesta�oninwhichonlyapart

ofthere�nadetachesandmayneedurgentsurgery.

InaStage-Vpa�ent,thecentreofthere�naortheen�re

re�nadetaches.Centralvisionisthreatenedandsurgeryis

o�en recommended to rea�ach the re�na. However,

results are o�en not favorable, with most children

remainingpermanentlyblind.

BATTLINGAGAINSTTHEODDS

26 27

EXAMINATIONOFREDREFLEXINNEWBORNS

1Examina�on of red reflex soon

a�er birth and per iodical ly

therea�er in EVERY NEWBORN

babyisacri�calmilestoneinthe

early detec�on of many serious

eyeproblems.Thisredreflextest

howevercannotdetectearlyROP.

Only a qualified and trained eye

specialist should perform ROP

screeningre�nalexamina�on.

Following pupillary dila�on using

eye drops, the baby's re�na is

examined in a dimly lit or dark

room, using a special lighted

instrument called an indirect

ophthalmoscope.

Examina�on of the re�na of a

pretermbabywilldeterminehow

farthere�nalbloodvesselshave

grown and whether or not the

vesselsaregrowingflatalongthe

walloftheeye.

1Theredreflexreferstothereddish-orangereflec�onoflightfromthere�naoftheeyethatis

observedwhenusinganophthalmoscopeorre�noscopefromapproximately30cmdistance.This

canalsobedetectedbyflashphotographyinadarkroomusingthecellphonecameraoraregular

digitalcamera.

26 27

EXAMINATIONOFREDREFLEXINNEWBORNS

1Examina�on of red reflex soon

a�er birth and per iodical ly

therea�er in EVERY NEWBORN

babyisacri�calmilestoneinthe

early detec�on of many serious

eyeproblems.Thisredreflextest

howevercannotdetectearlyROP.

Only a qualified and trained eye

specialist should perform ROP

screeningre�nalexamina�on.

Following pupillary dila�on using

eye drops, the baby's re�na is

examined in a dimly lit or dark

room, using a special lighted

instrument called an indirect

ophthalmoscope.

Examina�on of the re�na of a

pretermbabywilldeterminehow

farthere�nalbloodvesselshave

grown and whether or not the

vesselsaregrowingflatalongthe

walloftheeye.

1Theredreflexreferstothereddish-orangereflec�onoflightfromthere�naoftheeyethatis

observedwhenusinganophthalmoscopeorre�noscopefromapproximately30cmdistance.This

canalsobedetectedbyflashphotographyinadarkroomusingthecellphonecameraoraregular

digitalcamera.

NEWBORN CARE WEEK NOVEMBER 15-21

WORLD PREMATURITY DAY NOVEMBER 17

Pro

du

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by

LV

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Ins�

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