Causes of Retinopathy of Prematurity - Research Paper Example

? Retinopathy of Prematurity al Affiliation Babies who are born prematurely are among the most vulnerable groups tocontracting eye disorders. In the first 28 days of an infant’s life, he or she is especially prone to contracting Retinopathy of Prematurity. This condition of the eye is fervently correlated to premature birth, and is especially rampant among infants born after approximately 26 weeks of birth, or a lesser period of time over the course of the pregnancy. In its most acute cases, the condition results in fast, anomalous growth of blood vessels in the eye of the infant that ultimately result in leaks and bleeding. The aftermath is a scarring of the surface of the eye which exerts pressure on the retina forcing it to be more taut and detached from the wall of the eye. This can easily lead to loss of vision in the affected infants. Due to the lack of symptoms that can help in detection and early diagnosis of the condition in infants, the services of an ophthalmologist are required to carry out a specialized and intense eye examination. In many case, the problem does not escalate to an acute level, the condition clears up without the need for any treatment. The eyes however require to be continuously examined to ensure that the blood vessels do mature. Additionally, if the severity of the disorder in an infant exceeds what can naturally be outgrown, they can be administered with laser treatment to avert the loss of vision in infants. Keywords: Retinopathy of Prematurity, Infant, Retina, Eyes, Vision Introduction Wormald, Smeeth and Henshaw define Retinopathy of Prematurity as a “vasoproliferative disease of premature, low birth weight (LBW) babies, which occurs as a result of aberrant vascularization of the immature retina” (2004, p. 57). This condition of the eye is fervently correlated with premature birth and is especially rampant among infants born after approximately 26 weeks of birth, or a lesser period of time over the course of the pregnancy. For babies born prematurely, the normal process of the growth of retinal blood vessels may be upset. This may result in abnormal development of vessels, or the growth of abnormal vessels (Kopelman, 2009). As a result, the vessels that are abnormal may leak or bleed into the eye. Retinopathy of Prematurity occurs in five stages. A number of treatments have been tried and tested for the treatment of the condition. However, to date, the treatments that have been regarded as exuding the most efficacy in dealing with the condition are Laser Therapy or Cryotherapy (National Eye Institute, 2009). Risk Factors The greatest risk factor contributing towards the development of Retinopathy of Prematurity is premature birth (Hartnett, 2005). According to Kids Health, commencing from 16 weeks into the development of a baby in the uterus of their mother, the blood vessels begin to grow within a baby’s eyes; originating from the center of the eye (2013). By the eight month of the pregnancy, the blood vessels gradually branch out to the sides of the retina. For babies born prematurely, the normal process of the growth of retinal blood vessels may be upset. This may result in abnormal development of vessels, or the growth of abnormal vessels. As a result, the vessels that are abnormal may leak or bleed into the eye. The vessels that may have grown randomly in the eye may result in scarring, whereby the scars on the retina may shrink and tag on the retina. The effect of this tension on the retina may trigger the detachment of the retina from the back of the eye. This may result in the baby becoming blind due to the essential role that is played by the retina in the facilitation of the ability to see (Kids Health, 2013). Another risk factor that is suggested as being a cause of the condition is light, due to the fact that it “ leads to a release of free radicals that can cause oxidative damage, death of endothelial cells and release of angiogenic compounds” (Hartnett, 2005, p. 399). Researchers however pose differing opinions over the effects of lighting within the incubators of prematurely born babies on the development of the condition of Retinopathy of Prematurity. However, those in support of the idea that light may be a risk factor, to which the development of the condition can be attributed suggest the above proposition to support the argument that light can indeed affect the development of the condition. However, this matter remains debatable since further analysis conducted on a group of infants revealed that light exposure, especially within the first 24 hours after birth cannot be related directly to the occurrence or the gravity of the condition (Hartnett, 2005). According to Hartnett, subject to the time when they are administered, prenatal steroids may also serve as a risk factor in the development of Retinopathy of Prematurity (2005). The appropriate approach towards the dispensation of post-natal drugs, for example those used to treat diseases relating to the lungs is that they are best administered less than 2 weeks after birth. The postnatal administration of these steroids, especially after more than 3 weeks has been found to have undesirable and adverse conditions relating to the development of Retinopathy of Prematurity. Other potential risk factors as put forward in the New York Times include the phenomenon of Apnea, where the infant may temporarily stop breathing; suffering from heart disease is also a factor that instigates the risk of developing Retinopathy of Prematurity (2013). Low acidity of the blood characterized by a low pH of the blood is also a risk factor, as well as low levels of oxygen in the blood. Infections that may catch the infant, even when unrelated to the condition, put the baby at a risk of developing the condition. When the infant is under respiratory distress, which is also a risk factor, he or she may is more vulnerable to contracting the condition. Slow heart rate, commonly known as bradycardia, as well as transfusions also increase an infant’s risk of contracting the condition. All these factors separately contribute towards increasing the risk of an infant suffering from the development of Retinopathy of Prematurity, and the risk is especially higher when any of these factors is added to the fact that infant may have been born pre-term, in which case the chances of developing Retinopathy of Prematurity increase dramatically . Symptoms and Stages of Retinopathy of Prematurity Retinopathy of Prematurity occurs in five stages. According to Medline Plus (2013), these are: Stage 1: At this stage, the growth of blood vessels is mildly abnormal. Stage 2: At this stage, the growth of blood vessels is moderately abnormal. Stage 3: At this stage, the growth of blood vessels that are defective is severely abnormal. Stage 4: At this stage the growth of blood vessels is severely abnormal, while there is a partial detachment of the retina from the surface of the eye. Stage 5: At this stage, the retina is completely detached from the surface of the eye. The examination of the condition of the eyes blood vessels cannot the conducted with the naked eye and therefore requires a specialized examination of the eye. At this level, an infant may be said to be suffering from “plus disease” in cases of Retinopathy of Prematurity, where the infant has acute enlargement and twisting of the blood vessels complements, or surpasses what is expressed on an average photograph (Medline Plus, 2013). In acute cases of Retinopathy of Prematurity, the infant suffering from the condition may have irregular movements of the eye; this shows a sense of the loss of control over the movements of the eye. Further, acute Retinopathy of Prematurity can be demonstrated by the presence of pupils that look white in color, a condition known as leukocoria. There are also other symptoms of the condition; such as acute short-sightedness and crossed eyes (Medline Plus, 2013). Treatment of Retinopathy of Prematurity A number of treatments have been tried and tested for the treatment of Retinopathy of Prematurity. However to date, the treatments that have been regarded as exuding the most efficacy in dealing with the condition are Laser Therapy or Cryotherapy (National Eye Institute, 2009). Laser therapy is a technique whereby the edges of the retina are “burned away”. This is as a result of these eye margins having no blood vessels that are normally formed and functional (National Eye Institute, 2009). For cryotherapy, surgeons place a piece of eye treatment equipment that has the ability to engender freezing temperatures on the surface of the eye. Specific attention is paid to the sections of the eye where the edge of the retina is covered. For both forms of treatment, the abnormal growth of blood vessels is curbed or slowed down by the destruction of the marginal areas of the retina. This ensures that the condition is controlled. However, the negative aspect of these treatments is that some of the side vision of the individual undergoing the treatment is damaged in the process of curing the edges of the retina. This effect can however be justified by the fact that the most important aspect of vision is protected by these treatments. The precise, dominant vision that most people require to carry out their daily activities is the “straight ahead” vision. It enables activities such as reading books, sewing clothes, and driving vehicles, as well as other types of machinery (National Eye Institute, 2009). Laser therapy and Cryotherapy are however only carried out on infants with an advanced manifestation of Retinopathy of Prematurity, as is the case with stages 3 and above of the disease. This is due to the fact that they are viewed as intrusive eye procedures to which most physicians do not know the long side effects (National Eye Institute, 2009). As the disease advances to later stages, there are a variety of treatment choices that are available for tackling the condition. Among them are: Scleral buckle: A silicone band is placed along the periphery of the eye and thus the effect is a tightening of the eye. The vitreous gel within the eye is thus restricted form exerting tension on the scarred tissues within the retina and as a result, the retina lies flatly onto the wall of the eye. Infants who undergo this procedure can however not keep the silicone band on forever; it has to be removed anytime from months to a couple of years after it is placed around the eye of the patient. A failure to remove the band on the eyes which are continuously and gradually growing may result in the patient having undergone the treatment to become short-sighted. The procedure is preferably performed on infants who are in the fourth or fifth stage of their illness (National Eye Institute, 2009). The second procedure is known as Vitrectomy and is only advised to be performed at stage 5 of the condition. The procedure involves the removal of the vitreous gel. In its place, physicians place a saline solution. The scarring resulting from the leaking of blood vessels on to the retina can be removed by being pulled back, or being carved away from the retina. This procedure allows the retina to loosen as some of the previously exerted pressure is eased off. Additionally, the retina can lie back on the wall of the eye after the procedure is performed due to the eased tension (National Eye Institute, 2009). Conclusion It is important to identify the factors that influence the growth of Retinopathy of Prematurity just as much as it is essential to control the factors that contribute to its development. This is an important move in the prevention of the evolution of the condition into an acute illness that can threaten the sight of an individual. It also helps to contain the risk factors that propagate the condition by creation of awareness over the nature of the risk factors, and their individual consequences on the vision of an individual. Policies and approaches to inhibit the growth of Retinopathy of Prematurity depend on “optimization of oxygen saturation, nutrition, and normalization of concentrations of essential factors such as insulin-like growth factor 1 and ?-3 polyunsaturated fatty acids” (Hellstrom, Smith & Dammann, 2013). Additionally, these policies will aid in “curbing of the effects of infection and inflammation to promote normal growth and limit suppression of neurovascular development” (Hellstrom, Smith & Dammann, 2013). Reference List Hartnett, M. E. (Ed). (2005). Pediatric Retina. Philadelphia, PA: Lippincott, Williams & Wilkins. Hellstrom, A., Smith, L. E. H., & Dammann, O. (2013). Retinopathy of prematurity. The Lancet, Early Online Publication, doi:10.1016/S0140-6736(13)60178-6 Kids Health. (2013). About Retinopathy of Prematurity. Retrieved October 6, 2013, from http://kidshealth.org/parent/system/surgery/rop.html Kopelman, A. E. (2009). Retinopathy of Prematurity (ROP). Merck Sharp & Dohme Corp. Retrieved October 6, 2013, from http://www.merckmanuals.com/home/childrens_health_issues/problems_in_newborns/retinopathy_of_prematurity_rop.html Medline Plus. (2013). Retinopathy of prematurity. Retrieved October 6, 2013, from http://www.nlm.nih.gov/medlineplus/ency/article/001618.htm National Eye Institute. (2009). Facts About Retinopathy of Prematurity (ROP). Retrieved October 6, 2013, from http://www.nei.nih.gov/health/rop/rop.asp The New York Times. (2013). Retinopathy of Prematurity. Retrieved October 6, 2013, from http://health.nytimes.com/health/guides/disease/retinopathy-of-prematurity Wormald, R., Smeeth, L., & Henshaw, K. (2004). Evidence Based Ophthalmology. London: BMJ Publishing Group. Read More