Retinopathy of Prematurity Clinic COAVS

Retinopathy of Prematurity (ROP) is a condition observed in premature infants with low birth weight, characterized by the abnormal proliferation of blood vessels occurring at the intersection between the vascular and avascular regions of the retina. Retinopathy of prematurity (ROP) is a leading cause of childhood vision loss worldwide. Approximately 32,300 infants worldwide are diagnosed with irreversible vision impairment due to ROP annually, of which approximately 20,000 become blind or severely visually impaired.

 Objective statement:

• To raise awareness and provide education on the prevention, diagnosis, and treatment of Retinopathy of Prematurity (ROP) among healthcare professionals and parents of premature infants.
• To improve healthcare outcomes related to Retinopathy of Prematurity through education, early detection, and effective treatment strategies.

On the basis of above objectives ROP Clinic was established in 2012 under the supervision of Prof Dr Asad Aslam Khan Ex-Principal COAVS, the clinic is currently under the leadership of Prof Dr Moin (Principal COAVS). Regular eye examinations for premature infants at NICU are crucial to detect and manage ROP early.

In 2017, 52% of babies underwent screening, and this figure increased to 61% in 2018. In 2019, the screening rate was 57%, followed by a notable rise to 70% in 2020. However, in 2021, the screening percentage returned to 61%. These statistics represent the children who successfully survived.

 Risk Factors:

• Prematurity
• Low Birth weight (less 2kg)
• Less gestational age(35 weeks)
• Sepsis/EOS/IUGR/LOS
• Respiratory distress syndrome/surfactant therapy/oxygen therapy
• Pneumonia/RDS/HIE
• Multiple blood transfusions
• Severe intraventicular hemorrhage

Current guidelines for Screening at ROP Clinic at COAVS

The Infants falling below the birth weight of 2000 grams/2 KG or having a gestational age of 35 weeks or less constitute a specific category requiring heightened attention and care. In Addition, infants exhibiting both lower birth weights and gestational ages, coupled with unstable clinical co-morbidities, are identified as mostly vulnerable.

These criteria serve as critical indicators for healthcare professionals, guiding them in detecting and prioritizing infants who may face increased health risks due to premature birth or lower birth weight. The vigilant attention of these factors is principal in modifying medical interventions and ensuring that the delicate health conditions of these infants are addressed with precision and urgency.

Pre Screening Strategy:

Every day, sociologist makes regular visits to the Neonatal Intensive Care Units (NICU) and the nursery in the pediatrics department 1 and 2. The primary focus of these visits is to exactly document the details of premature babies based on specific criteria. The sociologist actively engages in raising awareness and providing counseling to parents regarding Retinopathy of Prematurity (ROP) Screening, emphasizing the importance of early detection and intervention. As part of the process, referral slips are thoughtfully placed in the admission files of babies, ensuring. A day before the scheduled screening, parents receives a call from ophthalmology department for the upcoming screening, typically conducted four weeks after the baby’s birth.

The screenings, supervised by Principal/Professor Dr. M. Moin, are held every Tuesday and Friday in the room number 114 eye ward Mayo hospital Lahore. For more information, interested individuals can visit https://www.properapak.org/ourteam.html  

Treatment:

Treatment options are depending upon severity of the disease which includes:

Laser therapy or / injection of medication into the eye to help prevent the progression of the disease. The long-term outcomes depend on the severity of the condition and the promptness of intervention. It is total preventable condition, if left undetected and untreated; it causes permanent blindness of the child.

Follow up

It is very important to follow the screening date given by the ophthalmologist. It’s essential for parents of premature babies to work closely with eye health professionals, including pediatric ophthalmologists, to monitor and manage any potential issues related to Retinopathy of Prematurity.

In the eye department of Mayo Hospital, we have fixed 2 days a week (every Tuesday & Friday)  for screening day in room number 114 for all children referred from NICU and periphery hospitals.

Current Challenges:

Although we are facing many some serious problem, which need to highlights like Infants passed away after being discharged, parents belonging from far flung or different cities, with inaccurate or switched-off phone numbers making it challenging to establish contact. Relatives are presently attending to the infants in hospitals, and the unfortunate circumstances are exacerbated by their poor economic condition and Parents don’t want to screen their babies.

Last but not least, the lack of health education awareness is a significant issue in our society that needs to be addressed through print, electronic, or social media.

ROP Team: (COAVS and Mayo Hospital Lahore)

• Sociologist
• Pediatric Ophthalmologist
• Pediatrician – (Paeds Unit 1 and 2)
• Sisters-in charge – (Ophthalmology and Paeds unit 1 and 2)
• Staff nurses – (Ophthalmology and Paeds unit 1and 2)
• Ophthalmic technician

Reference:

• Solebo AL, Teoh L, Rahi J. Epidemiology of blindness in children. Arch Dis Child. 2017;102:853–7. [PubMed] [Google Scholar] [Ref list]
• Blencowe H, Lawn JE, Vazquez T, Fielder A, Gilbert C. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res. 2013;74 Suppl 1(Suppl 1):35–49. [PMC free article] [PubMed] [Google Scholar] [Ref list]