Retinopathy of Prematurity (ROP) is a serious eye disease affecting premature infants, characterized by abnormal blood vessel growth in the retina, which can lead to retinal detachment and blindness if not detected and treated early.
today we're going to be talking about rop
rop
or retinopathy of prematurity so first
of all a disclaimer
i'm not an ophthalmologist but i am a
neonatologist and i think that i can
explain this to you in a way
so that you will understand rop so we
are going to go through different
aspects of rop first of all
what is rop who gets rop
why does rop develop how is rop
diagnosed how is rrp staged
and its overall treatment and prognosis
okay so let's start with what is rop rop
is retinopathy of prematurity
a disease that only premature infants get
get
if rop gets severe enough it ends up
with retinal detachment
and therefore has a high chance of
ending up with blindness or
really affecting the vision so the only
reason why we're screening babies for rop
rop
is to make sure that it never gets to
the stage of retinal detachment
the singer stevie wonder ended up losing
his vision because he was a 34 weaker
so a preemie born before we knew the
huge risk factor of developing rp he
ended up with wrestling's attachment
and therefore unfortunately lost his
vision because of that so
who gets rop just like every other
three-letter acronym in the nicu go
watch the other video on the
three-letter acronyms
rop occurs more severely as well as more frequently
frequently
in babies with a lower gestational age
as well as smaller babies
so the younger the baby the smaller the
baby the higher the risk of bad rop
in fact all babies born at less than 31 weeks
weeks
or less than 1500 grams need to be
screened for rop
the other huge risk factor for rop is
having a high oxygen requirement so if a
baby sat on an oscillator or ventilator
or even just
cpap at like a 100 fio2 for weeks on end
they have a much higher risk of
developing rop also generally just the
sicker the baby if they had more
infections they needed more surgeries
then that can also affect the chance of
them developing rp
finally just like everything else in
medicine genetics plays a big role
so babies can sometimes just inherit an
increased risk for developing rrp
so if a baby has an older sibling or a twin
twin
that developed rop even if they just
missed the cut off and eating screening
so if they're like 32 weeks or if they're
they're
1600 grams and their older sibling
developed rop
it might be worth screening them anyway
so why does rop develop let's go over a
quick anatomy lesson
the retina is a the layer right at the
back of the eye
that is responsible for taking the light and
and
converting it through the photoreceptors
which is the rods and the cones
into kind of neural messages which can
then travel to the brain
so that it can create an image so the
retina is kind of like the film
of the camera now also i want you to imagine
imagine
that the eyes are like globe so imagine
them like the back of a beach ball
the retina covers the back portion
of the globe so really
the most posterior aspect back here is
kind of the central part of the retina
and that's relevant when we're talking
about the zones
so like we said the retina is made up of
loads of the photoreceptors
normally when a baby is born at full term
term
the vascularization of the retina is
pretty much complete which means
that the retina has pretty much all the
blood supply that it needs
but when a baby is born pre-term the
blood supply is still beginning to
slowly cover the retina
where the blood supply comes from is the
retinal artery which comes out
right at the most posterior aspect of
the eye right where the optic disc
is then over the course of pretty much
the third trimester
the blood vessels slowly spread over the
back of the retina
until they're fully vascularizing the retina
retina
so if a baby is still in utero those
blood vessels grow
nice and flat along the back of the
retina until
the retina is fully vascularized but if
a baby is born prematurely
and for example is really sick or
exposed to high amounts of oxygen then
instead of those blood vessels growing out
out
nice and flat they start to grow forward
and right in front of the retina we have
gel-like substance
called posterior vitreous so if the
blood vessels start growing
forward into the posterior vitreous you
can imagine that if they get enough
grip or enough little blood vessels
clawing into that posterior vitreous
then eventually the posterior vitreous
if there's bleeding and scarring
will start pulling on the retina which
should be at the back of the globe
and if it pulls enough then it will end
up with a retinal detachment
so we worry about rop when there are
loads of those little red blood vessels
that are growing into the posterior
vitreous instead of nice and flat along
the back of the retina
so how is rop diagnosed ophthalmologists
diagnose rop they diagnose and treat rop um
um
ophthalmologists especially if they're
specialized in pediatrics or the retina
and they need to
directly visualize the retina and the
way that that is done
is very much like any eye exam that you
may have done so the pupils are dilated
with special
drops and then using a little
contraption to make sure that the eyes
stay open
the ophthalmologist will directly
visualize the retina
and see exactly how those blood vessels are
are
developing how far out they are so how
much of the retina is fully vascularized
as well as whether they're growing nice
and flat or whether they're growing
into the posterior vitreous so like we said
said
all babies who are born at less than 31
weeks and less than 1500 grams need to
be screened
for rop the first screening
needs to be done at either 31 weeks
correct gestational age or four weeks age
age
whichever happens latest so if a baby is
born at 29 weeks
then that baby will be screened at 33
weeks because
four weeks is later if a baby is born at
23 weeks then that baby will be screened
at 31 weeks correct or gestational age
the ophthalmologist will continue to
examine the babies every two weeks or
more often than that if they're a bit
more concerned
until the blood vessels have fully
vascularized the eye so
the blood vessels like we said slowly
creep over the back of the retina
until they reach the edge of the retina
when they're fully vascularized
and there's no rop as in there's no risk
of retinal detachment at that point
then the ophthalmologist can clear the
babies so how is rop staged
like most things in medicine the higher
the stage the worse it is
and it's exactly the same thing in with
rop as well
so the higher the stage the higher the
chance of retinal detachment
if a baby has rop stage zero they don't
have any rop
the blood vessels are growing completely
the way that they would grow in neutral
stage one and two means that the blood
vessels are beginning to grow a
little bit anteriorly into the posterior
vitreous stage three is means that
they've really got quite a lot of grip
into the posterior vitreous
stage four is a partial retinal
detachment and stage five
is a full retinal detachment so you can
imagine that once we reach kind of stage three
three
then the ophthalmologists are really
thinking about starting to treat so that
it doesn't progress to a stage four or
stage five again we're trying to avoid
the retinal detachment
ophthalmologists also talk about plus
disease plus disease is when
there's increased tortuosity of the
blood vessels that are kind of like
already grown into the posterior vitreous
vitreous
so they like become really twisty turny
and increases the chance further
that there's going to be bleeding and
more scarring and therefore again
a higher risk of retinal detachment the zones
zones
are the opposite the lower the zone the
scarier it
is to have some level of rop and that's because
because
the zones start off from zone one which
is the most posterior aspect of the retina
retina
then zone two is kind of like a bigger
circle around zone one
and zone three is the outer circle which
basically means that the blood vessels
have nearly reached the edge of the
retina the reason why rop is so scary in
zone 1
is that zone 1 in addition to including
the optic nerve
also includes the macula the center of
the macula is called the fovea
and the fovea has the highest
concentration of the photoreceptors the cones
cones
inside the whole retina so that is where
we get the increased sensitivity to our
light from so for example when you're
reading a book and your eyes are
scanning from left to right
you are putting your fovea on the
letters because that is like the best
vision that you have
so you can imagine that we really need
to protect
vision in zone one where the fovea is
and so really any rop in zone one can be
very concerning
zone two we worry about you know
obviously a little bit less and zone
three it's nearly vascularized
so if we have really any rp if we have
stage two rop in zone one it's concerning
concerning
and if you have kind of stage three rop
in zone two or zone three
then the ophthalmologists are more
concerned that this is gonna need treatment
treatment
so let's talk about treatment and
prognosis so like we said
threshold disease is considered when
there's a high chance of it developing
into a partial retinal detachment so
really stage two in zone one or stage
three especially with plus disease
in zone two or zo3 so what do the
ophthalmologists do
really right now there are kind of two
options the first one is laser treatment
where they're pretty much
lasering different areas of the eye kind
of more peripherally to kind of pad it
down to make sure that a retinal
detachment doesn't develop
or avastin which is also called bevercizumab
bevercizumab
which is an anti-endothelial growth
factor so basically they're injecting
a little bit of this really an immune
substance into the back of the eye
and preventing any more of the blood
vessels from kind of like proliferating
as much
so those are kind of like the two
established treatments if the babies
are treated and they prevent retinal detachment
detachment
then the babies generally have really
good prognosis and they have pretty good vision
vision
if you have any level of rop then there
is an increased chance of having myopia
anyway an increased chance of needing
eyeglasses and
really all preemie babies need to be
followed routinely
but if you don't end up with wrestle
detachment there's still a very good
chance that you can have absolutely
excellent vision
i hope you learned something today
remember to please like and subscribe
if you have any more questions about
this really complicated topic then please
please
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