You’re joyful yet worried. Your newborn came early, and they’re hanging in there. Still, you know that because of their early birth, they’ll have some challenges. Preemies are more likely to have health problems, including eye conditions. You should know the risk for vision problems and what you can do to help prevent vision loss.
Retinopathy of Prematurity (ROP)
This condition tends to occur only in premature babies. It usually affects both eyes (but can affect one worse than the other), and is the main reason children have vision loss. Babies who weigh about 2¾ pounds and are born earlier than 31 weeks are most likely to get it. Out of the 28,000 U.S. babies born weighing that much or less, as many as 16,000 will develop some form of ROP. Fortunately, most will have a mild case and won't need treatment. More severe forms can cause vision loss and even blindness if you don’t take care of them.
Development: Your baby’s eyes start to grow around 16 weeks. The most rapid growth happens in the last 12 weeks of pregnancy. Experts think premature birth interrupts this later growth, leading to ROP. Other risk factors include anemia, breathing problems, blood transfusions, and poor health. ROP causes blood vessels in the eye to grow abnormally and spread through the retina. These new blood vessels are fragile, and they leak blood into the eye. Scar tissue can form and pull the retina away from the back of the eye, causing vision loss.
Diagnosis: An eye exam is the only way to find it. If your baby is premature, ask the doctor if they need to be tested. Babies born at 30 weeks or younger, and those who weigh less than 3 pounds, need to be screened. If your child does need an exam, ask the doctor when the best time is. Four to 9 weeks after birth is normal, but it depends on when they were born. If the doctor doesn't find any signs, they shouldn't need follow-up exams.
Treatment: The disease has five stages. A retina specialist who examines a baby with ROP will know when to watch the condition and when to treat it, based on guidelines. Treatment may include:
- Cryotherapy (freezing) or photocoagulation (laser therapy) to stop the growth of blood vessels and keep the retina attached to the back of their eye.
- Scleral buckling, where the doctor places a band around your child’s eye. This pushes it inward, which helps keep the retina in place against the walls of the eye. The band will be removed in a few months or years.
- Vitrectomy, a more involved surgery. The doctor replaces the vitreous fluid inside your child’s eye with a saline solution. Then they remove any scar tissue from inside the eye. This allows the retina to relax in place against the eye wall.
- Medications placed inside the eye. Studies are ongoing to see if the medications that treat adult age-related macular degeneration can be used.
Complications: Children who’ve had ROP are more likely to get other problems later on:
- Myopia (nearsightedness)
- Strabismus (misalignment of the eyes)
- Amblyopia (lazy eye)
- Retinal detachment
Your child will need regular eye exams by a specialist as often as they recommend. If the doctor catches them early on, they can treat most of these conditions without any vision loss.
A small number of children will get strabismus -- eyes that don’t line up like they should. Infantile esotropia (one eye turning inward) is a type that affects premature babies. When the muscles that surround and control the eye don't work together, your child’s eyes will point in different directions. Doctors think it happens to preemies because the baby's brain hasn't developed enough to control their eye muscles. Other factors play into it as well:
- Brain or nerve problems like water on the brain, bleeding in the brain, seizure disorders, cerebral palsy, and other conditions
- Retinal damage from ROP
- A buildup of blood vessels under the skin (the doctor will all this a hemangioma) near the eye
- Brain or eye tumors
- A cataract or eye injury
- Developmental delay
- Genetic disorders
If your child has any of these conditions, they need to see a pediatric ophthalmologist -- an eye doctor who specializes in eye surgery and working with kids. Tell your doctor if you notice that your child's eyes are crossed.
Complications: Because the eyes focus in two different areas, the brain receives two different images. To make up for this, your baby's brain ignores the image from the crossed eye and processes only the image from the stronger eye. This can affect their depth perception. It can also lead to amblyopia, or lazy eye. This happens when the crossed eye doesn't develop good eyesight or even loses vision. About one-third of children with strabismus get amblyopia.
Treatment: If your child has amblyopia, the doctor will need to treat it first. They’ll block the stronger eye so their brain sees only images from the weaker one. They might use an eyepatch or drops that blur vision. This will strengthen their crossed eye and help them see better. They may not like the patch, but they need to wear it. Amblyopia can become permanent if it isn’t treated early.
Once their vision is stable, the doctor may do surgery to repair muscles around their eye. You may not want to put them through this at a young age. But their eyes will be better in the long run if they get treatment before age 2.
Even after surgery, they may still need glasses. Because strabismus can return, stick to the regular eye exam schedule their doctor recommends.