We have just had a baby. Do all newborns need to undergo vision screening?
The simple answer is – in some cases. The paediatrician usually does a ‘well baby’ check and it includes the red reflex check. Red reflex means seeing a red glow when shining a light from a specific instrument on the eye. The light passes through the front of the eye and reflects from the retina, giving a red appearance. This means that the pathway of light is unobstructed.
The absence of red reflex means that there is something obstructing the visual pathway – most commonly a cataract in a newborn. Less commonly, there could be problems at the back of the eye called the retina.
We are conducting a pilot study in which we are checking all newborn babies for potential pathology and have found that 1 per cent of the population had extreme refractive errors and have required corrective glasses.
More specifically, we have identified premature babies as a special concern in this region when it comes to vision-related problems, because of their particular vulnerability to retinopathy of prematurity (ROP). As a result, early screening is essential, with an eye examination for all premature babies to detect the condition, before leaving hospital.
ROP is a potentially blinding condition that affects premature babies and is one of the most common causes of visual loss in childhood. According to the American Academy of Ophthalmology, some countries in the region including in the GCC, have a severe incidence of ROP. Worldwide, every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising.
A full-term pregnancy has a gestation of 38–42 weeks. ROP primarily affects premature infants weighing about 1.5 kilograms or less that are born earlier than 31 weeks of gestation. The smaller a baby is at birth, the more likely the baby is to develop ROP, which usually develops in both eyes and if severe, can lead to lifelong visual impairment and blindness.
With the improving standard of neonatal care in the region, we are able to identify more premature babies and so more potential complications of preterm birth, including vision problems, such as ROP, which still remains a serious threat to the vision of babies. The condition is potentially preventable, subject to early screening and timely treatment, which is the key to the successful management of ROP.
Parents should be aware of the importance of early eye screening and parents of premature babies should request an eye test before they are discharged from hospital. These babies also need regular eye check-ups even after they are discharged from hospital, as they are at high risk of developing other vision abnormalities later in life, such as retinal detachment, myopia (nearsightedness), strabismus (crossed eyes), amblyopia (lazy eye), and glaucoma.
The good news is that many of these eye problems can also be treated or controlled.
Dr Irfan Khan is consultant ophthalmologist at Moorfields Eye Hospital Dubai