News Releases

April 1999

Emory offers latest treatments for retinopathy of prematurity

So much is at stake when a child comes into the world too soon. The heart, lungs, liver, kidneys and brain aren’t ready yet for the harsh realities of living and breathing. Especially when the baby exits the warm, protected environment of the womb at halftime, considerably before the normal 40-week gestation period.

Technology and expertise, though, have gotten us far, and more and more of these tiny babies survive and thrive. Even with the advent of good medicine, these babies can face another hurdle: a condition called retinopathy of prematurity or ROP. It’s a blinding disease of the retina, the part of the eye that translates light into visual messages.

“When a baby is born before 32 weeks of gestation, before the eyes have had time to form completely, the blood vessels that nourish the retina may develop abnormally, causing ROP,” said Antonio Capone, M.D., a retina specialist at the Emory Eye Center. In the majority of babies with ROP (85 percent), the abnormal blood vessels develop normally with time, usually during the first year of life. For the remaining 15 percent, the vessels abruptly stop developing, causing the retina to form a rim of scar tissue. This probably is caused by the untimely change in oxygen levels from inside the mother to the outside. The scar tissue can contract and detach the retina, causing blindness. Usually, the more premature the child, the more severe the condition.

“Once the scar tissue contracts, it’s like distorting a piece of film,” said Dr. Capone. “The visual system develops during childhood — especially during the first three or four months after birth — and all the circuitry between the eye and the brain is still being laid down. The child’s sight depends on a high-quality image coming in from the beginning.” Laser treatment when the baby is about 10 or 11 weeks old is only way doctors can correct the retinal distortion and prevent detachment. Dr. Capone and Eye Center surgeons David Saperstein and Paul Sternberg perform the procedure on about 50 babies a year. They regularly tote the laser, which weighs 20 pounds, to neonatal intensive care units in Atlanta and surrounding areas.

Even as recently as the 1980s, 90 percent of babies with the most severe form of ROP became blind without treatment and 75 percent went blind with the freezing treatment available at the time. Now with laser treatment, Dr. Capone and his colleagues, who were among the first to publish study results, have turned the tables completely around. They have protected the sight of nearly 90 percent of the children they have treated with laser. In addition, the Eye Center is pioneering a surgical procedure for the children with ROP who suffer from detached retinas. “Our approach at Emory is unique,” says Dr. Capone, “because we intervene early (about a month after laser treatment) to prevent worsening the detachment. We also spare the child’s lens. Both the surgery and the ability to save the lens give the child the best chance at having good vision.”

Since premature infants are at risk of developing eye problems later in childhood, the Eye Center’s pediatric ophthalmologists and other specialists round out the care these children receive. They can treat crossed eyes, prescribe glasses or lenses and provide treatment for glaucoma or cataracts should the child need special attention in the future. Researchers in the Eye Center’s laboratories also are looking into the reasons children develop these diseases and figuring out the best way to treat them.

Media Contact: Joy H. Bell

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