Time to rethink how we save sight in tiny babies

“It is time for paediatric ophthalmologists to reassess how best to screen and treat their smallest, frailest patients,” said Dr. John Flynn of Columbia University School of Medicine, speaking at the Paediatric Ophthalmology symposium, being held alongside the AAO in San Francisco.

Due to astonishing progress in neonatal medicine, younger and smaller babies than ever before are being saved: they often weight less than one pound and may be born 10 to 14 weeks early. Paradoxically, this medical progress has generated new healthcare challenges, including retinopathy of prematurity (ROP), a potentially blinding disease. ROP is more likely to occur in such tiny infants and to be severe and hard to treat successfully even with laser therapy, today's method of choice. Dr Flynn related the history of ROP to today's escalating treatment challenges and the search for new solutions.

From the 1970s onward, paediatric ophthalmologists have been increasingly able to reduce or cure ROP by adapting treatments developed for adult diabetic retinopathy. In the extremely premature infants saved today, though, all treatment parameters are more difficult and vulnerable to failure.

Since 1942, when the use of medically pure oxygen was introduced, doctors have been able to save many more premature babies. But the treatment has also contributed to an epidemic of ROP-related blindness and vision loss in the US and other countries that provide neonatal intensive care. ROP vision loss occurs due to abnormal growth and function of blood vessels that nourish the retina, the light-sensitive area in the back of the eye where images are formed for relay to the brain's visual cortex.