Retinopathy of prematurity - preventing childhood blindness
This research was completed on 30 June 2008
Published on 28 December 2005
Some 60,000 people around the world have been blinded soon after birth by a disease called retinopathy of prematurity. 1,2. This disease strikes babies who are born very prematurely. Blindness can be prevented, but difficulties with diagnosis mean babies are still losing their sight unnecessarily. Researchers are developing a straightforward screening tool, which could help save the sight of babies worldwide.
What's the problem and who does it affect?
Premature babies can lose their sight
Imagine how you'd feel if your newborn baby went blind even though treatment could have saved their sight. Sadly, that devastating scenario is all too common. Babies who are born very prematurely, at low birth weights, are at risk of an illness called retinopathy of prematurity, or ROP, which affects blood vessels inside their eyes. Blindness can be prevented if ROP is caught at the right time. Yet the illness causes up to 60% of childhood blindness in some developing countries, such as those in Latin America.1,3,4 These countries have the intensive care facilities needed to keep premature babies alive, but lack the specialist medical staff needed to monitor their eyes. Diagnosing ROP is difficult The main problem is that diagnosing ROP is very difficult. There's a lack of definitive, clear-cut information on the characteristics of diseased eyes, so diagnosis requires the personal judgement of an experienced ophthalmologist - a doctor specialised in diseases of the eye. Even in the wealthier countries of the world, ophthalmologists must devote a lot of time to screening babies for ROP, which still accounts for 3-8% of childhood blindness.4,5,6,7
What is the project trying to achieve?
Making diagnosis of deteriorating vision easier
The aim of this project is to improve the diagnosis of ROP. When deciding whether a baby needs treatment, ophthalmologists look for abnormalities in the blood vessels at the back of the eye. This is difficult, because the abnormalities are poorly defined. So, the first goal of this project is to provide a precise description of how the illness affects the blood vessels in babies' eyes. A second goal is to develop a picture library to guide ophthalmologists in their diagnosis of ROP. The library will contain images of the eyes of premature babies, both with and without ROP. It will cover the first few weeks of life, when ROP normally develops. The researcher's third goal is to develop a semi-automated, computerised screening tool. This will provide an objective measure of whether a baby needs treatment, by assessing digital images of the back of the eye. It will measure, for example, the diameter and branching patterns of blood vessels.
What are the researchers' credentials?
|Project Leader||Professor A R Fielder FRCP FRCS FRCOphth|
|Location||Department of Optometry and Visual Science, City University, London|
|Grant awarded||28 September 2005|
|Start date||1 July 2006|
|End date||30 June 2008|
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Professor Fielder has been a world leader in the field of ROP for many years. He has an excellent track record in diagnosing and treating premature babies with eyesight problems and in researching those problems. He is a member of an international committee working on the classification of ROP. The project team has all the knowledge, skills and resources needed to succeed. In particular, they already have access to two impressive databases, containing about 40,000 digital photographs of the eyes of premature babies with and without ROP. These images were obtained during routine screening of premature babies, mostly at St Mary's Hospital in London and Alberta Children's Hospital in Calgary, Canada.
Who stands to benefit from this research and how?
Nurses could take over diagnosis
Researchers hope their project will help stop premature babies from losing their sight to ROP. They plan to provide two important diagnostic tools - a computerised screening tool and a picture library - which could rapidly improve clinical practice. Researchers hope the computerised screening tool will allow nurses to take over the screening of premature babies for ROP. This presents an exciting opportunity to make screening routine even in countries where access to an ophthalmologist is limited. Babies in developing countries stand to benefit the most, where up to 60% of childhood blindness results from ROP. In richer countries, it could free up ophthalomologists' time and improve efficiency in the diagnosis of ROP. The picture library will be invaluable to ophthalmologists who do not have access to digital imaging technology and so cannot use the computerised imaging tool.
Routine screening could save babies' sight
Researchers hope their work will ultimately allow the screening of all babies at risk worldwide, so that they receive appropriate treatment in time to help save their sight.
1.Gilbert CE, Foster A. Childhood blindness in the context of VISION 2020 – the Right to Sight. Bull World Health Organ 2001;79:227-32. [back to main article] 2.World Health Organization. Preventing blindness in children: report of WHO/IAPB scientific meeting. Geneva, WHO, 2000. (Unpublished document, WHO/PBL/00.77) [back to main article] 3. Gilbert C, Rahi J, Eckstein M, O’Sullivan J, Foster A. Retinopathy of prematurity in middle-income countries. Lancet 1997;350:12-4. [back to main article] 4.Gilbert C, Fielder A, Gordillo L, Quinn G, Semiglia R, Visintin P, Zin A. Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: implications for screening programs. Pediatrics 2005;115:e518-25. [back to main article] 5.Haines L. Fielder AR, Pollock JI, Wilkinson AR: Retinopathy of prematurity in the UK: The organisation of services for screening and treatment. Eye 2002; 16: 33-38 [back to main article] 6.Brennan R, Gnanaraj L, Cottrell DG: Retinopathy of prematurity in practice 1: screening for threshold disease. Eye 2003; 17: 183-188 [back to main article] 7.Rahi JS, Cable N; British Childhood Visual Impairment Study Group: Severe visual impairment and blindness in children in the UK. Lancet 2003 362: 1359-1365. [back to main article]