[Nfbf-l] FW: Born early, sight suffers from the St. Pete Times 1/22/10

Fri Jan 22 19:25:28 UTC 2010

The following is an interesting article.  I noticed that it fails to mention
oxygen as a major cause of retinopathy of prematurity (ROP) when babies must
be   kept for a long period of time in an incubator.  I realize this link
between too much oxygen and blindness was discovered years ago, but when you
have a very tiny baby, incubators and oxygen are vital to keeping the child
alive.  Perhaps experts are finding that blindness is indeed caused by
extreme prematurity itself.

Sherrill

Born early, sight suffers

As more premature babies survive, cases of visual impairment are also on the
rise.

BY RICHARD MARTIN

Times Staff Writer

LARGO — Cynthia Romero Torres scoots around the room, chasing brightly
colored balls. She grabs a black crayon, then a chunk of neon orange
Play-Doh. Everyday stuff for an 18month-old.

But for Cynthia, these simple tasks mean major progress. She was born at
just 25 weeks’ gestation, weighing 1 pound. Her e yes were so
underdeveloped at birth, she’s had seven surgeries.

Now an otherwise healthy toddler, Cynthia illustrates a double-edged trend:
While survival rates of extremely preterm babies are rising , so is the
incidence of vision problems related to prematurity, including blindness.

Eye doctors and others who

? See SIGHT, 10A

Cynthia Torres, 18 months old, was born preterm with impaired vision. She
has therapy at Lighthouse of Pinellas.

? SIGHT continued from 3A

Premature babies at greater risk for vision problems

ser ve the needs of the visually impaired worry that they won’t be able to
handle this new wave.

“We’re not equipped,” Pinellas ophthalmologist Dr. Jeffrey Schwartz said.
The technology exists to help children like Cynthia, but costs are high,
the number of specialists is limited and many mothers who have preterm
babies don’t have health insurance, he says.

“The issue is access,” adds Dr. Jonathan Mines of Bay Area Retina
Consultants. “There are patients that get through the cracks because they
are indigent and don’t have appropriate care.” And Dan Mann, president and
CEO of the nonprofit Lighthouse of Pinellas, worries whether groups like
his — which rely on government money — will be able to provide training and
therapy to the growing visually impaired population, particularly now as
the state wrestles with a budget deficit.

“Across the board I’m concerned,” Mann said.

• • • Advances in neonatal care have helped doctors save more tiny babies
than ever before. A 2009 study published in the Journal of the American
Medical Association showed markedly higher one-year sur vival rates for
infants born at less than 27 weeks between 2004 and 2007 compared with
similar babies born between 1990 and 1992. (Full term is considered to be
about 40 weeks.) But early preterm infants, those born before 27 or 28
weeks, are at greater risk of many medical problems, including hearing
loss, cerebral palsy and vision impairment.

A Swedish study found a higher incidence of retinal damage, called
retinopathy of prematurity, in babies born before 27 weeks. These babies
also are at greater risk of glaucoma and amblyopia, more commonly known as
lazy e ye.

Much of the e yes’ development takes place in the last 12 weeks of a 40-week
gestation. So in cases of preterm babies, “the retina hasn’t had time to
develop,” Schwartz said.

Retinopathy of prematurity is the abnormal development of blood vessels in
the retina, which is the tissue that lines the back of the e ye. Retinopathy
can occ ur when a preterm birth halts the normal growth of blood vessels to
the edges of the retina.

T he disorder is treated by using laser therapy or cr yotherapy to destroy
the outside of the retina, which will slow or reverse the abnormal growth of
blood vessels. Essentially, the smaller a baby is at birth, the more likely
the baby will develop vision problems. Of the approximately 28,000 babies
born each year that weigh 2¾ pounds or less, more than half have some degree
of retinopathy. Some cases are mild and require no treatment, but others
require surger y, and about 400 to 600 infants each year become legally
blind from the disorder.

What’s more, the number of children born preterm is increasing. Nearly 13
percent of all U.S. births are preterm, compared with 11 percent 15 years
ago.

Babies arrive too soon and too small for many reasons. But Schwartz says
proper prenatal care is ke y to helping more babies make it to full term
and lessen the chances of visual impairment.

“If you’re born before you’re fully developed, you may not fully develop,”
he said.

• • • Doctors say the earlier the eye disorder is diagnosed, the better the
child ’s visual prognosis.

Marisol Torres, 30, said her daughter faced many medical challenges when she
was born extremely preterm at Bayfront Medical Center in St. Petersburg.
Cynthia was bleeding from her heart and lungs, and Torres said doctors told
her the baby had little chance to sur vive.

But she did, and when Cynthia was 1 month old, doctors discovered she had
re tinopathy of prematurity in both eyes. She has since had seven surgeries
to treat the disorder. Though her vision is good now, it’s uncertain whether
she’ll need eyeglasses or have substantial vision loss in the future.

“The doctor says there’s a big chance she will not be totally blind,”
Torres, a Clearwater resident who is from Me xico, said through a
translator.

Cynthia and other visually impaired children ge t aid from agencies such as
Lighthouse of Pinellas, which works with them in developing cognitive
skills, motor skills and speech.

Lighthouse ser ves about 30 to 40 children a year, and Mann expects that
number to grow as the visually impaired population increases.

Anna Kiefriter has been using Lighthouse ser vices for much of her son
Nicholas’ life. Nicholas was born at Bayfront when Kiefriter, who
experienced complications through her pregnancy, was only 24 weeks along.
Doctors soon learned Nicholas had retinopathy of prematurity.

Now two months shy of his sixth birthday, Nicholas is a kindergartener at
Our Lady of L ourdes Catholic School in Dunedin, where his mother is a music
teacher.

Nicholas is legally blind in his right eye, and his left eye is only
slightly better. He has limited peripheral vision, caused by the damage to
the outer portions of his retina.

He has had surgery, and has worn glasses since he was 10 months old.
Kiefriter says she has lost count of how many pairs he has gone through.

But, she says, he never takes them off. Even when he sleeps.

“He always wants to see,” Kiefriter said.

Richard Martin can be reached at rmartin at sptimes.com or (727) 893-8330