December 9, 2003
By Carey Hamilton,
The Salt Lake Tribune.
Robert Hoffman places numbing drops into a tiny infant's brown eyes.
Wrapped in a white blanket, Sharif Takwa -- a premature baby who weighed 1 pound 13 ounces when she was born in August -- lies in the recovery ward at University Hospital in Salt Lake City.
Takwa, of Magna, begins to cry as Hoffman, a pediatric ophthalmologist at the Moran Eye Center, pries open one of her eyes with an eyelid speculum. Carefully, he prods her eye with another instrument and examines her retina.
It's an unsettling procedure. "The baby fusses during this, but they don't understand we're doing something that could potentially help them," Hoffman says.
A national study released on Monday reveals that early treatment in premature babies like Takwa can help prevent blindness.
As part of the study, 32 patients were treated at University Hospital, one of 26 study centers nationwide conducting research, with Hoffman taking the lead in Utah.
The results of the clinical trial, sponsored by the National Institutes of Health, may help doctors find better ways to treat infants suffering from retinopathy of prematurity (ROP). The disorder mostly afflicts babies who are born before 31 weeks of gestation -- 40 weeks is the full gestational period -- and weigh less than 2.75 pounds.
The disease is caused when abnormal blood vessels grow from tissue that should be developing normal blood vessels in the retina, the membrane that lines the back of the eye. The abnormal vessels are weak, can leak and cause scarring of the retina, pulling it out of position. Retinal detachment can lead to poor vision or blindness. Typically, ROP develops in both eyes. Experts believe premature babies are more prone to ROP than full-term babies because the eye develops rapidly during the last 12 weeks of pregnancy.
ROP annually affects 14,000 to 16,000 premature infants in the United States. Each year, about 400 to 600 babies with ROP become blind.
Although the study, which began in 2000, is ongoing, preliminary findings show that early detection and treatment of severe ROP significantly reduces the incidence of poor vision or blindness. The findings have led to revised standards for identifying premature infants with severe ROP.
Previously, doctors waited until the risk of retinal detachment approached 50 percent.
Earlier treatment reduced the likelihood of poor vision from 19.5 percent to 14.5 percent at 1 year of age. Screenings begin about four to six weeks after birth.
"It is crucial that infants with high-risk ROP be identified early and be given timely treatment," said William Good of the Smith-Kettlewell Eye Research Institute in San Francisco.
Good presided over the study. "Early treatment could save infants from a lifetime of visual impairment."
To treat ROP, doctors use laser therapy or cryotherapy. Laser therapy uses heat from light energy while cryotherapy uses freezing temperatures to slow abnormal blood vessel growth. Both treatments result in a partial loss of peripheral vision but preserve most of the sight.
The Utah researchers used laser therapy instead of cryotherapy, which is the standard.
"Studies show laser is as effective as cryotherapy," Hoffman said. "Cryotherapy makes the eye redder, more sore, and it's more difficult on infants."
The laser therapy takes about 15 to 30 minutes, Hoffman said.
The study will follow the enrolled infants until the age of six. Josiah Stamper, 3, of Centerville was one of the first patients enrolled in the U. study.
Hoffman performed laser surgery on Josiah's left eye a few months after his birth, at 25 weeks gestation.
"If Doctor Hoffman wouldn't have done the procedure, his retina probably would have detached," said Stacey Stamper, Josiah's mother.
Jordan now wears glasses for an astigmatism in one eye and near-sightedness in the other, but at least he can see.
"I'm so glad they caught it early," Stacey said.
© Copyright 2003, The Salt Lake Tribune.
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