Prevention of ROP is best accomplished by decreasing premature births. However, premature births have not decreased; rather, smaller and more immature infants are surviving. Several prevention strategies have been trialed and continue to be investigated.
Oxygen has been associated with ROP since the early 1950s. In early studies, when oxygen administration was limited, the incidence of ROP dropped, but survival rates decreased and the prevalence of cerebral palsy increased. Subsequently, it was discovered that the oxygen level in the blood, rather than the amount of oxygen delivered, contributed to the development of ROP. Today, research continues to look at minimizing oxygen supplementation at stable levels in an effort to decrease the severity of ROP, while still preserving optimal oxygenation to vital organs.[12,18] A recent clinical trial found a significant decrease in the rate of severe ROP following an educational program and strict implementation of oxygen management and monitoring. The protocol included maintaining oxygen saturations at lower levels for very-low-birth weight infants and avoiding wide swings in oxygenation.
Early studies implicated environmental lighting as a factor in the development of ROP. Meta-analysis of research on this topic found that decreasing retinal ambient light exposure in premature infants is very unlikely to reduce the incidence of ROP.
Antioxidants are also being studied for their role in preventing ROP. Large dose vitamin E as a prevention measure was studied in the 1980s, but significant side effects halted clinical trials, and many physicians have abandoned the practice. Inositol, an antioxidant found in breast milk, is under investigation for its potential in reducing the severity of chronic lung disease. An unexpected finding in the preliminary results is a decreased incidence of ROP.
Gene therapy for inherited or acquired ocular diseases is also under investigation. Animal trials indicate that gene transfer to an eye using adeno-associated viral (AAV) vectors may be promising for infants with ROP.
NAINR. 2003;3(3) © 2003 W.B. Saunders
Cite this: Does My Child Really Need to Wear These Glasses? A Review of Retinopathy of Prematurity and Long-Term Outcomes - Medscape - Sep 01, 2003.