The eyes need the full duration of pregnancy to develop properly. If a baby is born too early, the retina is still in a process of development. Exposure to the outside world often changes the development of the retina and can lead to severe eye disease. Abnormal vascular growth develops and can lead to detachment of the retina, the inner lining of the eye. This disease is called retinopathy of prematurity, or ROP, and this can lead to blindness.
Exposure to high oxygen levels while babies were in the incubator has shown to increase the risk of ROP, and in the past many of these babies became blind. The shorter the pregnancy, and the smaller the baby, the higher is the risk of severe ROP. At the highest risk are babies who at birth weigh 1500 grams or less, or who are born before 31 weeks of pregnancy. These babies receive extra care in the form of eye screening.
Every week doctors from Retina of Coastal Carolina and NICU nurses of the Betty Cameron Childrens Hospital look at these very small babies and perform eye exams through dilated pupils. The exams of these tiny eyes is difficult, and stressful for these small patients, but they are absolutely necessary. The retina is mapped with a drawing at each visit; sometimes photographs can be taken with a special camera for documentation.
Once ROP is diagnosed, the baby is seen weekly, sometimes more often. ROP is expressed in stages of development and location on the retina; according to international standards. Once a certain degree of severity is reached, treatment is recommended. This consists of laser treatment to the undeveloped part of the retina, usually to both eyes. In most cases this will stop progression of ROP. Rarely laser alone will not be sufficient. In these cases certain drugs can be injected into the eye to stunt the growth of abnormal blood vessels.
If laser or injections are not sufficient in stopping ROP, intra-ocular surgery is the last resort. Nurses, retinologists and pediatric ophthalmologists continue to follow these babies even after discharge from the hospital. All of this is done in Wilmington; babies do not have to travel to Duke or UNC anymore. Thanks to the vast improvements in the care by NICU doctors and nurses almost all of these very small babies can go home with good vision and have an excellent start in their early life.