Two year eye check

Talia and I were at PMH this week for a check with the opthalmologist.

Our last visit was a year ago, and I was a bit concerned about how she would react this time as a year ago she was a lot more placid! Fortunately it all went pretty smoothly.

Firstly a doctor held up some cards for her to look at, checking that she looked in the direction of the picture on each card (some with picture at the top, some at the bottom), using both eyes equally. The pictures were line drawings on a grey background, and at first they were thick lines and easy to see, but at the end they were very fine lines that were difficult to distinguish from the background. There was also a very groovy plastic card with 3-D pictures on a speckly grey background that you can only see using both eyes (I tried it myself, the pictures completely vanish if you cover one eye).

Next she had eyedrops put in - and you would be impressed with the strength of Talia’s eyelid muscles! She really tried very hard to keep her eyes shut. So that was a bit traumatic but I had been expecting it.

Last, after her eyes dilated, the opthalmologist did the checks using a little torch and looking through lenses held just in front of her eyes. I was expecting this part to be a total nightmare, but the doctor was a man with lots of toddler experience - he turned it into a game of peek-a-boo. So after a few initial squawks, she decided the whole thing was great fun and happily co-operated.

So… after all that, the verdict is: her eyes are currently exhibiting normal vision. This sounds great, but actually at Talia’s age they expect children to be slightly long-sighted, as she was at her one year check. So it looks like she has already started her journey to short-sightedness. (I knew it would happen, both my husband and I and all our parents are short-sighted, but I had kind of hoped it might take a little longer to become evident.)

Talia’s next eye appointment will be in 9 months time.

Retinopathy of Prematurity (ROP)

What is it?Finisterre.minti.com

Retinopathy refers to damage to the retina, the light-sensitive membrane lining the back of the eye which is responsible for transmitting images to the brain.

In order to function, the retina requires a network of blood vessels. This blood supply normally develops during pregnancy starting around week 16 and finishing by 36 weeks. If a baby is born prematurely, with the retina’s blood vessel development incomplete, problems can occur. Abnormal blood vessels may develop which can subsequently lead to bleeding and scar tissue formation. In severe cases this may then stretch the retina, pulling it out of position. ROP normally affects both eyes.

Regardless of the gestational age at birth, ROP seems to occur at about 37 to 40 weeks.

Who is at risk from ROP?

ROP mainly affects babies who are born at less than 32 weeks gestation weighing less than 1250 grams. The smaller a baby is at birth, the more likely that baby is to develop ROP. However in over 90% of cases, the ROP is mild and will resolve without treatment.

Other factors contributing to the risk of ROP include anaemia, blood transfusions, breathing difficulties, and the overall health of the baby.

Traditionally high oxygen exposure was believed to be the main cause of ROP, and it was common in the 1940s and early 1950s when hospital nurseries began using excessively high levels of oxygen in incubators. With newer technology and methods to monitor the oxygen levels of babies, oxygen use as a risk factor has diminished in importance.

Why is it a problem?

Most babies who develop ROP have a mild case (referred to as Stage 1 or Stage 2) which does not require treatment. These babies recover completely and the ROP leaves no permanent damage.

However, in a small number of babies, ROP worsens, sometimes very rapidly. If left untreated in more severe cases (Stages 3-5), ROP is one of the most common causes of vision loss in childhood and can lead to lifelong eyesight problems and in very severe cases, blindness. The singer Stevie Wonder was a premature baby who became blind as a result of ROP.

How is it treated?

Premature babies have their eyes checked while they are still in hospital, and again after they have been discharged. Mild cases do not need treatment as they will correct by themselves. If the ROP does not resolve by itself, it will continue to form scar tissue which may threaten to detach the retina. Early detection and treatment (if required) reduces the risk of severe ROP developing.

The usual treatment in Australia for severe ROP is laser therapy. Doctors use lasers to “burn away” the outer edge of the retina to slow or reverse the abnormal growth of blood vessels. Unfortunately, this treatment also destroys some side vision. This is done to save the most important part of a baby’s sight—the sharp, central vision needed for “straight ahead” activities such as reading and driving.

Are there any long term problems if my baby had ROP which resolved?

Babies who had ROP are considered to be at higher risk for developing certain eye problems later in life, such as retinal detachment, nearsightedness, crossed eyes, lazy eye, and glaucoma, but in most cases these eye problems can be treated or controlled.

This is one of a series of articles I’ve written for the L’il Aussie Prems newsletter under the heading of Premmie Health. Read my disclaimer here.