Interview with Professor Armin Wolf, Deputy Hospital Director, Eye Hospital, Ludwig-Maximilians-University Munich
Retinopathy of Prematurity (ROP) is a condition that is found in the eyes of very preterm born babies. It is characterised by changes in the developing blood vessels of the retina (the light-sensitive layer in the back of the eye that sends visual signals to the brain). If detected timely, it can usually be treated and a blindness can be prevented. Still, it is a condition of the eye that can have long-term effects. We would like to learn a bit more about these long-term effects of ROP today.
Question: Professor Wolf , is follow-up for their eyes important for all preterm born patients, or only for a certain group (e.g. children who have been treated for ROP)? And why?
We know from various studies there are risk factors for developing ROP in a preterm infant. However, we know only little about the sequelae of this eye condition with the child growing older. Therefore, there is a screening for the child until it reaches its normal gestational age. Thereafter, controls are recommended according to findings. However, if we look at the sequelea that occur in adult age, it seems not to be dependent on whether the patient was treated during the critical time of ROP development. Nevertheless, we have to take into account that treatment of ROP has not always been the same within the last 40 years, thus we will need to continue studies on the late courses of former ROP, often referred to as adult ROP.
Question: How long should the eyes of these babies be checked for and how often?
According to the current German guidelines for screening for ROP a continuous follow-up after reaching normal gestational age is recommended for preterm children with a birth weight of less than 1500g or a gestational age of less than 32 weeks. For children with a gestational age of 32 to 36 weeks a regular follow-up is recommended until the 6th year. Every eye – and every patient with ROP is different, therefore it has to be decided based on every case. Especially if there are additional health problems, follow-up may need to be performed at shorter periods as it is not always easy to asses retinal status.
With new medical treatment modalities, we have seen late reactivation of ROP in very few cases, however, these cases must be identified. Currently, we have very little data from long-term follow-up of ROP patients. We are aware that they are at higher risk for retinal detachment, glaucoma and other ocular pathologies, however, we have too little data to draw conclusions. It seems that an eye that has gone through the active phase of ROP during early childhood, independent from treatment, seems to be a ”special eye also in the light of future treatment. Therefore, a treating surgeon will always need to know about the patient having been a preterm infant, and it seems that the birth weight does play a role in the individual risk.
Question: What is done during an eye follow-up examination after the baby has reached its due date and does it hurt?
Basically speaking, these examinations aim at examining the same structures that are examined during the active phase of ROP after birth at the NICU. In these examinations, pupil is dilated and the fundus (the back of the eye) is examined. Most of these patients are used to ophthalmic examinations, therefore, it is usually possible in a standard examination at the ophthalmologist. Only in few cases or if there is a possibly relevant finding during a standard examination, the examination has to be performed under full anesthesia to rule out relevant findings.
Testing the visual acuity and determining the refraction (i.e. the glasses the patient needs to wear), as well as examining the need to patch one eye to assure equal bilateral development are also part of these routine examinations. Invasive examinations are usually not necessary.
Question: Who can check the eyes of these babies and later children?
In general, these examinations may be done by any ophthalmologist. However, if the ophthalmologist feels uncomfortable or if there was an ROP diagnosis, a specialised ophthalmologist for retina or a specialised center may be senseful.
Question: Regarding follow-up, what is your advice for children who developed ROP?
We tend to look at ROP patients especially in their young ages. At this age, follow-up is mandatory. However, with children growing up, preterm birth tends to be “forgotten”, and at later age there are only few patients that have regular follow-up examinations. I recommend to stick to lifelong follow-up with intervals depending on the clinical findings to avoid complications such as retinal detachments. In an uncomplicated ROP for example I do follow-up examinations year-wise.