Saving preemies' sight

Newborns are at risk for blindness.

Children's Hospital of Illinois now has a high-tech eye on those babies.

The hospital, located at OSF Saint Francis Medical Center in Peoria, Ill., owns one of 400 RetCam imaging systems in the world and one of only nine in the state.
"This is a tremendous asset to the community," said Dr. Steve Lichtenstein of Illinois Eye Center.

RetCam, sold by Clarity Medical Systems Inc., of Pleasanton, Calif., is the latest technology to help detect retinopathy of prematurity, or ROP.

Because preterm babies' retinas aren't fully developed, they are at risk for ROP.

"(Premature) babies actually stop growing with the delivery process," said Theresa Lanier, one of three Children's Hospital nurses trained to use the RetCam. "They kind of restart growing like 4-6 weeks later. Then, they grow really rapidly. It's like they're trying to make up for that time that they weren't growing.

"Because they're growing so rapidly, blood vessels just proliferate in that area and put tension on the eye. That's when we really have to watch them, during that rapid growth phase."

If vessels grow too rapidly, the retina can detach. The result is irreversible blindness.

"It's not a lot," Lichtenstein said of the frequency of blindness. "The problem is, it's permanent. Once the child is blind, the child is blind."

The first of three RetCam models was sold starting in 1997. The RetCam II model has been used in Peoria since January, a month after Children's Hospital spent about $90,000 for the computerized system and accompanying hand-held camera. The fiber-optic camera provides real-time images and still photos.

Lichtenstein, former chairman of the American Academy of Pediatricians Section on Ophthalmology, estimates about 15 percent of newborn babies will require laser surgery or more complicated eye surgery.

The latest guidelines from pediatric and ophthalmology experts call for all babies born at 30 weeks or sooner or weighing less than 1,500 grams (a little more than 3.3 pounds) to be tested for ROP.

Children's Hospital has tested about 100 newborns using the new system.

Lichtenstein and four other ophthalmologists - Illinois Eye Center partners Jean Vahey and Pete Lagouros, plus Kamal Kishore and Chittaranaja Reddy - rotate viewing newborns' eyes utilizing the RetCam II.

GETTING THE DATA

Many parents are uneasy watching the ROP test.

After drops numb the lids, the infant's eyes are pried open using small clips. A swab is used to move the eyes.

First, an indirect ophthalmoscope is attached to the doctor's head. The device illuminates the eye for a preliminary exam, but it doesn't record data.

To use the RetCam, the nurse places the hand-held lens above one of the baby's eyes. The ophthalmologist views the image on the screen, makes a diagnosis and saves a copy of the image. Saved images allow for comparisons of the eye's development during follow-up tests.

Babies continue exams until retinas develop properly. Surgery can only be performed on healthy babies.

"We have to wait until they're stable," Lichtenstein said. "Some of these kids are so sick, they can't even undergo this (test), let alone undergo the surgery. Once they're stable enough to undergo laser treatment or the regular surgery, then they have the surgery."

Julia Sollberger appears likely to avoid surgery.

Born more than 8 weeks premature on Aug. 22, 2006, the daughter of Shawn and Angela Sollberger has been tested three times and now will go six months before her next exam.

"It's scary," Shawn Sollberger said of the test. "It's kind of weird the first time you see it. The second time it's a little easier.

"They noticed that she's a little far-sighted. They hope over the next six months that'll go away. If not, she'll need glasses."

The ability to view photos, as well as their daughter's relatively healthy eyes, brings comfort.

"We'd read up on prematurity, but we really had no idea about the eyes," Shawn Sollberger said. "This technology is pretty awesome.

"(The doctor) explains everything they're looking for and what it would look like in different situations. Her eyes are doing great, but he explained what it would look like if they weren't."

High-quality, computerized photos are a far cry from the previous method in which doctors drew charts of the eye by hand. RetCam technology allows for easier consultation.

"If I had to show a colleague what it looked like, my hand drawing doesn't show it as well as the picture shows it," Lichtenstein said. "They would have to go with what my interpretation is saying."

Many ophthalmologists shy away from examining newborns because of malpractice fears. To make up for a shortage of doctors in some areas, "telemedicine" is used.

Any facility with a RetCam can forward an image to a doctor at another site.

One large telemedicine operation is the Stanford University Network for Diagnosis of Retinoplathy of Prematurity based in California.

Remote diagnosis is not performed at Children's Hospital, which serves premature babies from a 26-county area.

But Dr. Jim Hocker, medical director of the hospital's neonatal intensive care unit, likes the documentation aspect.

"It's good for a teaching tool," Hocker said. "This is a teaching hospital with all kinds of students and residents. We've never really been able to see exactly what our babies' retinas looked like. We were only able to see an image from a book. Now we can all see it.

"Plus, it's good for parents. Parents can see exactly what we're talking about. Before, they really couldn't."

Saved images could provide precise evidence at a multimillion-dollar malpractice trial, which makes a $90,000 investment look like a bargain to Hocker and his staff.

"It also helps a lot with non-accidental trauma or shaken baby syndrome," Lichtenstein said. "If a baby has hemorrhages in the back of the eye, that's probably going to go to court. It's much easier to show a picture of what the back of the eye looked like instead of trying to argue against a defense attorney (asking), 'Did you really see what you thought you saw, Doctor?' You can say, 'Here's the picture.' It helps a lot."