0:10 today we're going to be talking about rop
0:11 rop
0:13 or retinopathy of prematurity so first
0:15 of all a disclaimer
0:16 i'm not an ophthalmologist but i am a
0:18 neonatologist and i think that i can
0:20 explain this to you in a way
0:22 so that you will understand rop so we
0:24 are going to go through different
0:25 aspects of rop first of all
0:29 what is rop who gets rop
0:32 why does rop develop how is rop
0:34 diagnosed how is rrp staged
0:36 and its overall treatment and prognosis
0:39 okay so let's start with what is rop rop
0:41 is retinopathy of prematurity
0:44 a disease that only premature infants get
0:45 get
0:48 if rop gets severe enough it ends up
0:49 with retinal detachment
0:51 and therefore has a high chance of
0:53 ending up with blindness or
0:55 really affecting the vision so the only
0:57 reason why we're screening babies for rop
0:58 rop
0:59 is to make sure that it never gets to
1:02 the stage of retinal detachment
1:05 the singer stevie wonder ended up losing
1:07 his vision because he was a 34 weaker
1:10 so a preemie born before we knew the
1:12 huge risk factor of developing rp he
1:14 ended up with wrestling's attachment
1:15 and therefore unfortunately lost his
1:17 vision because of that so
1:20 who gets rop just like every other
1:22 three-letter acronym in the nicu go
1:22 watch the other video on the
1:24 three-letter acronyms
1:27 rop occurs more severely as well as more frequently
1:28 frequently
1:30 in babies with a lower gestational age
1:32 as well as smaller babies
1:34 so the younger the baby the smaller the
1:36 baby the higher the risk of bad rop
1:39 in fact all babies born at less than 31 weeks
1:40 weeks
1:42 or less than 1500 grams need to be
1:44 screened for rop
1:46 the other huge risk factor for rop is
1:48 having a high oxygen requirement so if a
1:50 baby sat on an oscillator or ventilator
1:51 or even just
1:55 cpap at like a 100 fio2 for weeks on end
1:56 they have a much higher risk of
1:59 developing rop also generally just the
2:00 sicker the baby if they had more
2:02 infections they needed more surgeries
2:03 then that can also affect the chance of
2:05 them developing rp
2:07 finally just like everything else in
2:09 medicine genetics plays a big role
2:11 so babies can sometimes just inherit an
2:13 increased risk for developing rrp
2:16 so if a baby has an older sibling or a twin
2:17 twin
2:19 that developed rop even if they just
2:21 missed the cut off and eating screening
2:23 so if they're like 32 weeks or if they're
2:23 they're
2:26 1600 grams and their older sibling
2:27 developed rop
2:29 it might be worth screening them anyway
2:32 so why does rop develop let's go over a
2:33 quick anatomy lesson
2:36 the retina is a the layer right at the
2:37 back of the eye
2:40 that is responsible for taking the light and
2:40 and
2:43 converting it through the photoreceptors
2:45 which is the rods and the cones
2:47 into kind of neural messages which can
2:48 then travel to the brain
2:51 so that it can create an image so the
2:53 retina is kind of like the film
2:55 of the camera now also i want you to imagine
2:56 imagine
2:59 that the eyes are like globe so imagine
3:01 them like the back of a beach ball
3:04 the retina covers the back portion
3:07 of the globe so really
3:10 the most posterior aspect back here is
3:12 kind of the central part of the retina
3:14 and that's relevant when we're talking
3:15 about the zones
3:17 so like we said the retina is made up of
3:20 loads of the photoreceptors
3:22 normally when a baby is born at full term
3:23 term
3:25 the vascularization of the retina is
3:27 pretty much complete which means
3:29 that the retina has pretty much all the
3:31 blood supply that it needs
3:34 but when a baby is born pre-term the
3:36 blood supply is still beginning to
3:38 slowly cover the retina
3:41 where the blood supply comes from is the
3:42 retinal artery which comes out
3:44 right at the most posterior aspect of
3:47 the eye right where the optic disc
3:49 is then over the course of pretty much
3:50 the third trimester
3:53 the blood vessels slowly spread over the
3:55 back of the retina
3:57 until they're fully vascularizing the retina
3:58 retina
4:01 so if a baby is still in utero those
4:02 blood vessels grow
4:04 nice and flat along the back of the
4:05 retina until
4:08 the retina is fully vascularized but if
4:10 a baby is born prematurely
4:11 and for example is really sick or
4:14 exposed to high amounts of oxygen then
4:15 instead of those blood vessels growing out
4:16 out
4:19 nice and flat they start to grow forward
4:21 and right in front of the retina we have
4:23 gel-like substance
4:26 called posterior vitreous so if the
4:28 blood vessels start growing
4:30 forward into the posterior vitreous you
4:33 can imagine that if they get enough
4:35 grip or enough little blood vessels
4:37 clawing into that posterior vitreous
4:39 then eventually the posterior vitreous
4:41 if there's bleeding and scarring
4:43 will start pulling on the retina which
4:45 should be at the back of the globe
4:47 and if it pulls enough then it will end
4:48 up with a retinal detachment
4:52 so we worry about rop when there are
4:54 loads of those little red blood vessels
4:55 that are growing into the posterior
4:57 vitreous instead of nice and flat along
4:58 the back of the retina
5:02 so how is rop diagnosed ophthalmologists
5:05 diagnose rop they diagnose and treat rop um
5:06 um
5:07 ophthalmologists especially if they're
5:09 specialized in pediatrics or the retina
5:10 and they need to
5:12 directly visualize the retina and the
5:14 way that that is done
5:16 is very much like any eye exam that you
5:18 may have done so the pupils are dilated
5:19 with special
5:21 drops and then using a little
5:22 contraption to make sure that the eyes
5:23 stay open
5:25 the ophthalmologist will directly
5:27 visualize the retina
5:30 and see exactly how those blood vessels are
5:30 are
5:33 developing how far out they are so how
5:35 much of the retina is fully vascularized
5:37 as well as whether they're growing nice
5:39 and flat or whether they're growing
5:41 into the posterior vitreous so like we said
5:42 said
5:44 all babies who are born at less than 31
5:46 weeks and less than 1500 grams need to
5:47 be screened
5:51 for rop the first screening
5:54 needs to be done at either 31 weeks
5:57 correct gestational age or four weeks age
5:57 age
6:00 whichever happens latest so if a baby is
6:01 born at 29 weeks
6:04 then that baby will be screened at 33
6:04 weeks because
6:07 four weeks is later if a baby is born at
6:09 23 weeks then that baby will be screened
6:12 at 31 weeks correct or gestational age
6:14 the ophthalmologist will continue to
6:17 examine the babies every two weeks or
6:18 more often than that if they're a bit
6:19 more concerned
6:21 until the blood vessels have fully
6:22 vascularized the eye so
6:24 the blood vessels like we said slowly
6:26 creep over the back of the retina
6:29 until they reach the edge of the retina
6:31 when they're fully vascularized
6:34 and there's no rop as in there's no risk
6:36 of retinal detachment at that point
6:37 then the ophthalmologist can clear the
6:40 babies so how is rop staged
6:42 like most things in medicine the higher
6:44 the stage the worse it is
6:46 and it's exactly the same thing in with
6:48 rop as well
6:49 so the higher the stage the higher the
6:51 chance of retinal detachment
6:54 if a baby has rop stage zero they don't
6:54 have any rop
6:56 the blood vessels are growing completely
6:58 the way that they would grow in neutral
7:00 stage one and two means that the blood
7:02 vessels are beginning to grow a
7:04 little bit anteriorly into the posterior
7:06 vitreous stage three is means that
7:08 they've really got quite a lot of grip
7:09 into the posterior vitreous
7:11 stage four is a partial retinal
7:13 detachment and stage five
7:15 is a full retinal detachment so you can
7:18 imagine that once we reach kind of stage three
7:18 three
7:20 then the ophthalmologists are really
7:22 thinking about starting to treat so that
7:24 it doesn't progress to a stage four or
7:26 stage five again we're trying to avoid
7:27 the retinal detachment
7:29 ophthalmologists also talk about plus
7:32 disease plus disease is when
7:34 there's increased tortuosity of the
7:35 blood vessels that are kind of like
7:37 already grown into the posterior vitreous
7:38 vitreous
7:40 so they like become really twisty turny
7:42 and increases the chance further
7:43 that there's going to be bleeding and
7:45 more scarring and therefore again
7:48 a higher risk of retinal detachment the zones
7:48 zones
7:51 are the opposite the lower the zone the
7:52 scarier it
7:54 is to have some level of rop and that's because
7:55 because
7:58 the zones start off from zone one which
8:00 is the most posterior aspect of the retina
8:01 retina
8:03 then zone two is kind of like a bigger
8:05 circle around zone one
8:07 and zone three is the outer circle which
8:09 basically means that the blood vessels
8:11 have nearly reached the edge of the
8:14 retina the reason why rop is so scary in
8:15 zone 1
8:17 is that zone 1 in addition to including
8:18 the optic nerve
8:20 also includes the macula the center of
8:22 the macula is called the fovea
8:24 and the fovea has the highest
8:26 concentration of the photoreceptors the cones
8:27 cones
8:31 inside the whole retina so that is where
8:33 we get the increased sensitivity to our
8:35 light from so for example when you're
8:36 reading a book and your eyes are
8:38 scanning from left to right
8:39 you are putting your fovea on the
8:41 letters because that is like the best
8:42 vision that you have
8:45 so you can imagine that we really need
8:46 to protect
8:49 vision in zone one where the fovea is
8:52 and so really any rop in zone one can be
8:53 very concerning
8:55 zone two we worry about you know
8:57 obviously a little bit less and zone
8:59 three it's nearly vascularized
9:01 so if we have really any rp if we have
9:03 stage two rop in zone one it's concerning
9:04 concerning
9:06 and if you have kind of stage three rop
9:08 in zone two or zone three
9:09 then the ophthalmologists are more
9:11 concerned that this is gonna need treatment
9:11 treatment
9:13 so let's talk about treatment and
9:14 prognosis so like we said
9:17 threshold disease is considered when
9:19 there's a high chance of it developing
9:21 into a partial retinal detachment so
9:24 really stage two in zone one or stage
9:26 three especially with plus disease
9:29 in zone two or zo3 so what do the
9:31 ophthalmologists do
9:32 really right now there are kind of two
9:35 options the first one is laser treatment
9:36 where they're pretty much
9:39 lasering different areas of the eye kind
9:40 of more peripherally to kind of pad it
9:42 down to make sure that a retinal
9:44 detachment doesn't develop
9:46 or avastin which is also called bevercizumab
9:47 bevercizumab
9:50 which is an anti-endothelial growth
9:52 factor so basically they're injecting
9:54 a little bit of this really an immune
9:56 substance into the back of the eye
9:58 and preventing any more of the blood
10:00 vessels from kind of like proliferating
10:01 as much
10:03 so those are kind of like the two
10:05 established treatments if the babies
10:08 are treated and they prevent retinal detachment
10:09 detachment
10:10 then the babies generally have really
10:12 good prognosis and they have pretty good vision
10:12 vision
10:15 if you have any level of rop then there
10:17 is an increased chance of having myopia
10:19 anyway an increased chance of needing
10:20 eyeglasses and
10:21 really all preemie babies need to be
10:23 followed routinely
10:25 but if you don't end up with wrestle
10:27 detachment there's still a very good
10:28 chance that you can have absolutely
10:30 excellent vision
10:32 i hope you learned something today
10:34 remember to please like and subscribe
10:35 if you have any more questions about
10:37 this really complicated topic then please
10:37 please
