The eye is like a camera with a lens in front and a film (retina) at the back. The retina is located approximately two centimeters behind your pupil. It is shaped like a small cup. The retina converts the ocular image into a signal that is sent to the brain. The central part of the retina, called the macula, is used for straight-ahead vision and what is in your direct line of sight.
A healthy macula is crucial for tasks involving fine vision such as reading, recognizing faces and distinguishing things.
The area surrounding the macula helps in mobility and in seeing from the ‘corner’ of the eye, though it is not useful for fine work.
The retina is connected to the brain by the optic nerve. Blood is supplied to the retina and the optic nerve by blood vessels that maintain the health of these tissues. In front of the retina is the vitreous cavity, which is filled with a gel-like substance, called the vitreous.
Diseases of the retina, the vitreous, and the optic nerve can cause serious vision problems. Fortunately, most of them can now be managed satisfactorily with modern methods of diagnosis and treatment.
Remember, early diagnosis and prompt and appropriate treatment can result in a better outcome.
Retinopathy of Prematurity
Why should I worry about the eyes of a premature baby?
While from outside the eye looks ‘normal’, the inside of the eye, the retina, is not fully developed in premature babies. Abnormal blood vessels can develop in such a retina. These abnormal blood vessels can cause internal bleeding and even retinal detachment. This is called Retinopathy of Prematurity (ROP). This condition results in low vision or blindness – both of which are irreversible.
Unfortunately, eyes who start to develop ROP have no changes seen on the outside and babies cannot complain that they are losing their vision silently. Hence it is very critical and mandatory to get retinal screening for ROP in premature born babies.
How can we detect ROP?
A trained ophthalmologist can detect ROP by dilating the pupils of the eye using eye drops. An indirect ophthalmoscope is used to scan the entire retina to detect ROP and gauge the state of retinal maturity. A fundus imaging camera can also be used for the same.
Do all babies need a retinal examination for ROP?
As per Govt. of India RBSK guidelines, babies with a birth weight of less than 2000 grams or those born in under 34 weeks of pregnancy are most likely to have ROP. (remember 2-34 rule)
Pre-term babies who have birth weight more than 2000 grams or born after 34 weeks but had problems after birth such as breathing problems, lack of Oxygen, infections, blood transfusions etc., are also vulnerable and need retinal examination.
Is it too late for my baby’s eyes?
Follow the “Day-30” strategy. The FIRST retinal examination should be completed before “day-30” of the life of a premature baby. It should preferably be done earlier (at 2-3 weeks of birth) in very low weight babies (<1200 grams birth weight).Remember ‘Tees Din Roshni ke- Thirty Days to Vision!
What is the treatment for ROP?
ROP is treated with Laser rays, injections to the eye, surgery and sometimes a freezing treatment (Cryopexy). The treatment helps stop further growth of abnormal vessels or prevents progression of retinal detachment, thus preventing vision loss.
How often should the retina be examined?
ROP can progress in 7-14 days and therefore needs a close follow-up till the retina matures. More than one examination may be needed in babies before they are declared out of danger. Do not miss ROP follow-up appointments as each visit is critical.
When should we treat ROP?
ROP needs to be treated within 72 hours or earlier, as soon as it reaches a critical stage called High risk pre- Threshold ROPor there is aggressive ROP (AROP). There is greatest risk of vision loss if left untreated after this. Time is crucial!
After treatment
IIf treated in time, the child is expected to have reasonably good vision. All premature babies need further regular eye examinations till they start going to school.
They may need glasses or treatment for lazy eyes/ cross-eyes and sometimes, for cataract, glaucoma and retinal detachment.
