Sharon Enemuoh: Everything You Should Know About Retinopathy of Prematurity and How it Affects Babies

Babies can be born before the normal gestational age of 38-42 weeks for various reasons. When babies are born before 37 weeks, they are considered premature and may be at risk for a condition called Retinopathy of Prematurity (ROP). ROP is a potentially blinding eye disease that occurs due to abnormal blood vessel growth and spread in the retina, which is the part of the eye responsible for vision. The disease is particularly prevalent in low birth-weight infants or babies born before 31 weeks gestational age. While not all preterm babies develop the condition, it is one of the leading causes of childhood blindness worldwide. 

What is Retinopathy of Prematurity (ROP)?

Retinopathy of Prematurity occurs when a baby’s eyes develop abnormally after preterm delivery. In the last stages of pregnancy, the blood vessels in a baby’s retina typically finish developing. However, should a baby be born before 31 weeks of gestation or weigh less than 1,500 grams (3.3 pounds), there is a great chance that the blood vessels in the retina may not have fully developed thereby resulting in the possibility of abnormal blood vessels being formed, which may lead to complications such as retinal detachment and blindness. One or all of these occurrences is referred to as ROP.

ROP can be divided into five stages. Stages 1 and 2 are mild, and the abnormal blood vessel growth may resolve without treatment. Stage 3 may require some form of intervention, while Stages 4 and 5 involve partial or complete retinal detachment. These must be treated urgently as they can lead to severe vision loss or blindness. Timely diagnosis and treatment are critical in preventing severe vision impairment.

ROP in Sub-Saharan Africa

There is a lack of statistics for ROP in sub-Saharan Africa, including Nigeria due to limited resources, under-reporting, and lack of awareness of the disease in addition to poor public healthcare systems leading to an increase in the mortality of babies born prematurely. However, this is changing and becoming a growing concern as healthcare systems in sub-Saharan Africa are gradually improving and the survival rates of premature infants also are on the increase.

In developed countries, ROP is one of the most common causes of childhood blindness, affecting approximately 50% of babies born under 28 weeks. In sub-Saharan Africa, there is only an estimated statistic of around 20-30% of premature babies at risk of developing ROP. However, actual numbers may be higher due to lack of knowledge, limited screening, and the absence of specialised care.

In Nigeria, there is a growing recognition of the impact of ROP (Retinopathy of Prematurity) on causing blindness. This is evident from the increase in the number of public neonatal units screening for the condition, which has risen from 6 units in 2017 to 20 units in just one year. Additionally, a study at Lagos University Teaching Hospital revealed that up to 29% of premature children with visual impairments were affected by ROP. However, the actual extent of the problem may not be fully understood due to underreporting caused by inadequate neonatal screening programs and a lack of national statistics. Furthermore, the shortage of resources for screening and management, as well as the lack of coordination between trained pediatric ophthalmologists and optometrists, could also be contributing factors.

Several factors contribute to the lack of comprehensive statistics on ROP in sub-Saharan Africa.

Limited Access to Neonatal Care

Many premature babies are born in rural areas with limited access to advanced neonatal care such as specialised neonatal units, incubators, and trained healthcare professionals and so many premature babies may not survive long enough to be diagnosed with ROP.

Insufficient Screening Programs

In many African countries, ROP screening is not routinely conducted in neonatal care units due to the shortage of resources such as trained manpower, and medical equipment as well as the absence of standardised guidelines for screening premature infants for ROP.

Lack of Awareness

Many healthcare providers and parents are not aware of ROP and its potential impact on vision leading to underreporting, delayed diagnosis, and a lower priority given to eye health in neonatal care settings.

Limited Funding and Resources

Our healthcare systems in sub-Saharan Africa often face significant resource constraints as such the available resources are focused usually on reducing infant mortality rates, and conditions like ROP may receive less attention compared to other pressing health issues leading to future strain on the same system from the burden of care for a visually disabled child.

What Should Parents Know About ROP?

For parents of premature babies, understanding the risks and implications of ROP is crucial especially as babies born before 31 weeks of pregnancy or weighing less than 1,500 grams are at higher risk. Ask your doctor if your baby has been screened for ROP, as early detection can make a significant difference in the outcome.

Also, parents should understand that ROP can progress without any obvious symptoms, so regular eye exams are essential, starting around 4-6 weeks after birth enabling doctors to monitor the development of the retina and detect any signs of abnormal blood vessel growth early enough to prevent severe vision loss.

Finally, parents must ensure their little one receives the best possible neonatal care, as factors such as oxygen therapy, infection control, and general health management can influence the risk of ROP.

What Do Doctors Look for When Diagnosing ROP?

When screening a baby for ROP, healthcare practitioners will consider several key factors, including the stage of the disease. Doctors assess the stage of ROP to determine the severity of abnormal blood vessel growth. Stages 1 and 2 may not require treatment, but Stages 3-5 will need intervention. The location of abnormal growth in the retina will also be checked. If the abnormal blood vessels are closer to the centre of the retina, there is a higher risk of affecting vision. Doctors will examine how much of the retina is affected by abnormal blood vessels and whether there are any signs of retinal detachment. ROP can change as the baby grows, so regular follow-up exams are critical for tracking the condition’s progress and deciding on the appropriate time for treatment if needed.

Treatment or Management 

The treatment and management of ROP depend on the severity of the condition. Mild cases of ROP often resolve on their own without any intervention while severe cases will require interventions. Available options include Laser therapy and cryotherapy. Anti-VEGF injections and Surgery. Based on the Stage and Zone of the location of the ROP in the eyes, the pediatric ophthalmologist specialising in treatment will advise on the best treatment options for your baby.

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