Combating the scourge of ROP

Children's eye health is a vital area of child care. In the past, it was thought that immunisation campaign against some infectious diseases, administering Vitamin A drops to fight night blindness and morbidity among children, etc. were all about taking care of child health. But with the advances in medical science, new areas critical to child health, especially children's eye health, have emerged. One such area of concern is Retinopathy of Prematurity (ROP), which is an eye condition that afflicts prematurely born babies with very low birth weight (less than three pounds). According to the World Health Organization (WHO), premature or preterm birth is when babies are born alive before 37 weeks of their mothers' pregnancy is completed. There are also cases of 'very preterm birth' when infants are born before 28 to 32 weeks of pregnancy and 'extremely preterm birth' when it happens before 28 weeks of pregnancy.

The problem is, ROP, which involves abnormal growth of blood vessels in the retina (a light-sensitive layer of tissue at the back of the eyeball) of a newborn baby's eyes, shows no early symptoms at birth. Even during the first 14 to 15 days of birth, the symptoms do not show up. But in the later phase, the symptoms like unusual eye movements and loss of vision become evident. Once diagnosed, the infant must undergo treatment immediately, which may include laser therapy, injection or surgery. However, for ROP of the milder variety, simple observation (of course by doctors) will suffice. In such cases, the symptoms, if any, ultimately disappear without causing blindness to the affected child. An important part of managing ROP to prevent blindness among neonates is to conduct eye examination (screening) within 30 days of their birth.

Going by a UN report, 12.5 per cent (about 400,000) of the three million children born every year in Bangladesh are cases of premature birth. Of them, according to another study, 22.6 per cent have low birth weight (less than 2.5 kg). Though in developed countries, the incidence of ROP is between 10 to 27 per cent and accounts for 10 per cent of child blindness, no such statistics is available in Bangladesh on the number of prematurely-born babies suffering from ROP-induced blindness. The number must be higher primarily because in the underprivileged segment of society malnutrition among pregnant women is pervasive. As undernourished mothers are more prone to give birth to underweight babies including preterm ones, it can be safely assumed that the percentage of ROP among the newborns in Bangladesh should also be high. In that case, campaigns to raise awareness about ROP, among the public, especially, women and health workers should be launched from time to time. At the same time, apart from occasion-based meetings, workshops and gatherings to share experiences among health professionals in this field of paediatric eye care, routine training programmes on management and screening of ROP should be conducted.

In this connection, at a recent scientific seminar held at the Bangabandhu Sheikh Mujib Medical University (BSMMU), specialist doctors informed that annually, 40,000 children suffer from blindness in the country. Obviously, a good number of such cases of blindness are ROP-induced. Ophthalmologists informed that 23.7 per cent of the premature and low birth-weight infants were found to be cases of ROP. So, as a first step towards combating the scourge of ROP, a database is required to be developed on it from the records maintained at different hospitals and clinics in the country. The database should be regularly updated.