The physicians who are taking care of your baby have asked an ophthalmologist (eye doctor) to examine your child's eyes. This examination is especially important because your child was born prematurely and may have special eye problems that need careful attention.
When a baby is growing inside its mother, it is in a protected environment. The baby develops slowly, until he or she is able to continue growing outside the mother.
The retina is the inner lining on the back wall of the eyeball. The retina is the part of the eye that receives sight through the pupil and sends it to the brain. (You might think of the eye as a camera: the retina is the film.) The retina receives blood through blood vessels. These blood vessels are the last part of the eye to develop just before a full-term baby is born. So when a baby is born early (prematurely), the retinas of that baby's eyes are not fully developed.
WHAT IS RETINOPATHY OF PREMATURITY?
Retinopathy of Prematurity is the name of a disease that frequently affects the eyes of very small premature babies. Physicians are still not sure of all the reasons why, but the blood vessels in the retinas of some premature babies do not develop in the way they should. This abnormal blood vessel growth is called Retinopathy of Prematurity (or "ROP" for short). In spite of the best care hospitals can give, ROP still develops in certain infants. We have noticed that ROP is more likely in the very smallest babies who have the most complications. Signs are usually apparent while they are still in the Newborn Intensive Care Unit.
ROP can cause blindness, but not for most babies. If ROP does develop, one of three different things can happen:
1) In the majority of premature babies with ROP, the blood vessels that are not growing correctly heal completely before the baby is one year old.
2) In some infants, the blood vessels that are not growing correctly will leave scarring in the retina when they heal. These babies may have to wear glasses because they are nearsighted (myopic). They may also develop lazy eye (amblyopia) or a wandering eye (strabismus). Medical care can usually correct these problems if the child is seen by an eye physician (M.D. or D.O.) at an earlyage. It is important that an ophthalmologist continue to examine your baby's eyes regularly, to be sure that your child reaches school age with the best possible vision.
Sometimes, the partially healed ROP leaves worse scarring in the retina that might cause eye problems that cannot be fixed by glasses or even by surgery. To control the damage as much as possible, these children need medical eye care regularly for the rest of their life.
3) When scarring in the eye from ROP is the worst, the blood vessels in the retina keep on growing incorrectly and form into a large amount of scar tissue, which can shrink and pull the retina loose from the inside of the eye. This is called retinal detachment. Retinal detachment usually means that the baby will not be able to see well or it might even mean that the baby will become blind. Fortunately, this happens only to a very small number of eyes with ROP (about 4.5%).
The doctors who are taking care of your baby are watching carefully for any signs of Retinopathy of Prematurity. This may mean that your baby will need eye examinations for the next few weeks or months. If your baby's eyes are developing the more severe kind of ROP, the doctors will talk with you about surgery to help protect your baby's vision. The ophthalmologist who examines your baby's eyes can answer any questions you have about ROP.
WHAT ABOUT YOUR BABY'S EYES?
Your baby needs another examination because he/she
_____ Has a normal examination now but could still develop problems later.
_____ Has early Retinopathy of Prematurity. We need to do more examinations to see if the ROP could get worse.
If your baby stays in this Newborn Intensive Care Unit, the next eye exam will be in about _______ weeks.
If your baby is sent to another hospital, we urge you to make sure the doctors know if your baby has had ROP. Even if there was no ROP on the first exam, the eyes are not necessarily "safe” and eye exams need to be done for your baby.
If your baby is sent home, find out from your baby's doctor when you need to bring the baby for the next eye exam. If in doubt, please call:
DO NOT POSTPONE THE SCHEDULED EXAMINATION. THE TIMING COULD BE EXTREMELY IMPORTANT.
Reprinted with permission from Multicenter Trial of Cryotherapy for Retinopathy of Prematurity and CRYO-ROP Headquarters.
Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP). (n.d.). About a premature baby’s eyes [Brochure]. Portland, OR: Oregon Health & Science University, Casey Eye Institute.
Visual Conditions Module 06/04/04
S3 Handout D: Premature Baby’s Eyes