August 14, 2009

Screening key to halting vision disorder in premature infants

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Twins Isabel and Owen Willers benefited from an early screening for retinopathy of prematurity, which can cause blindness. (photo by Anne Rayner)

Screening key to halting vision disorder in premature infants

Retinopathy of prematurity (ROP) is the leading cause of irreversible blindness in children worldwide. If detected early, it can be treated.

But the diminishing number of trained specialists to screen premature babies for ROP is making it a tough condition to manage.

“It is becoming increasingly more difficult for NICUs to retain appropriate physician coverage to provide these exams,” said Franco Recchia, M.D., chief of the Retina Division at the Vanderbilt Eye Institute (VEI).

Nationally, the number of ophthalmologists performing screening exams for ROP has dropped by half, said Recchia. Thankfully, Vanderbilt sees things differently, he said. As other hospitals are cutting back on screenings, VEI specialists are stepping up.

Recently Vanderbilt began providing eye care screenings for Erlanger Children’s Hospital in Chattanooga.

“We felt that this was an important enough service for the good of these children and we were very willing to provide the services,” said Recchia.

“We know that most children who are born early will develop some degree of ROP. While it usually regresses spontaneously, there are still a significant number of patients who are at risk for vision loss if not treated with laser surgery.

“Of the babies we screen, about 10 percent require laser treatment and we do this procedure within 48 hours of diagnosis,” Recchia said. “When correctly applied, it reduces the chance of an unfavorable outcome by 90 percent.”

Recchia said that as advances in neonatal care grow, more fragile children are surviving.

“The overall incidence of ROP has not increased, but we are seeing more severe cases because the younger these babies are born and the smaller they are, the more at risk they are for developing severe ROP.

For the Willers family, the routine screening for ROP was essential. Born at 27 weeks gestation, twins Owen and Isabel spent 10 weeks in the NICU at the Monroe Carell Jr. Children's Hospital at Vanderbilt. Although the first two exams showed no cause for alarm, it was the follow-up appointment that proved eye opening.

Mom Elisabeth Willers, M.D., was on the verge of leaving the routine ophthalmology checkup because certain equipment necessary to monitor her son’s heart was not available.

“Once we were discharged from the hospital, I was so ready to move on,” said Willers, an assistant professor of Medicine in the Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt. “They had been through so much with surgeries, infections and exams.

“Here I was waiting for their appointment and growing impatient,” Willers said. “I had two children both on oxygen and with feeding tubes. When the monitoring equipment wasn't available, I almost left. Thank God I didn’t.”

Isabel Willers was diagnosed with an aggressive form of ROP, and was in surgery the next day.

“I figured she had some mild form, so I was really shocked with the diagnosis,” said Willers. “I have no doubt that if we had left that day Isabel would undoubtedly have had vision problems or even blindness.”
Owen’s eyes were checked the next day. He did not require surgery.

“Our daughter could have lost her eyesight if we had not followed up. We’re very fortunate. Now she has phenomenal vision. Dr. Recchia saved her eyesight,” Withers said.

In addition to serving the Vanderbilt NICU, VEI ophthalmologists and retina specialists screen nearly two dozen patients during their East Tennessee visits, which includes Johnson City.

In the United States, nearly 600 infants each year are blinded from ROP, which is the growth of abnormal blood vessels in the retina. The fragile and leaking vessels cause scarring that leads to retinal detachment, which is the main cause of visual impairment and blindness in ROP.