KUALA LUMPUR – While parents routinely keep track of developmental milestones such as crawling and talking, eye health from birth is often overlooked.
Data from the Malaysian National Neonatal Registry shows that 10.7 per cent of premature babies born before 32 weeks develop stage one or two retinopathy of prematurity (ROP), while two per cent develop severe ROP that can threaten their sight permanently.
Emphasising the importance of early eye care, ParkCity Medical Centre consultant adult and paediatric ophthalmologist Dr Goh Siew Yuen said premature babies face a higher risk of eye problems because their eyes are still developing when they are born.
"During pregnancy, the eyes continue to develop inside the womb. When a baby is born too early, some important parts of the eye, including the blood vessels supplying the retina, are not yet fully developed.
"The blood vessels in the retina usually begin developing at around 16 weeks of pregnancy and continue growing towards the edges of the retina until the baby reaches full term.
"When babies are born prematurely, for example at 28 or 34 weeks, these blood vessels may not have reached the outer parts of the retina, leaving some areas without enough oxygen," she explained.
After birth, premature babies may also require oxygen support. Changes in oxygen levels can cause the blood vessels in the retina to grow abnormally.
"ROP is a time-sensitive eye condition. Without timely treatment, it can worsen and eventually lead to blindness," Dr Goh said.
She compared the abnormal growth of these blood vessels to building a road without a proper foundation.
She said if the blood vessels grow too quickly, they can be very fragile and may bleed easily inside the eye.
As the disease progresses, scar tissue can form and pull on the retina, eventually causing the retina to detach and this can result in permanent blindness, she added.
Dr Goh also highlighted Malaysia’s Clinical Practice Guidelines on the Management of ROP, which recommend eye screening for premature babies born before 34 weeks of pregnancy or weighing less than 1,750 grammes at birth.
Babies who have had an unstable clinical course may also need screening even if they do not meet these criteria.
She cautioned that babies with ROP usually do not show any obvious symptoms. In fact, babies in general may not be able to show parents that they have a vision problem.
"That is why regular eye screening is important. Parents should not wait until they notice something unusual with their baby’s eyes before seeking help," she said.
She said a white reflection from the pupil, sometimes noticed in photographs or under certain lighting, can be a sign of a serious and more advanced eye condition adding that by the time this becomes visible, the disease may already be at a late stage.
Other factors, including severe illness, prolonged use of a breathing tube, infections such as sepsis and blood transfusions, she said can further increase the risk of ROP.
"Treatment for ROP may include laser treatment or injections of anti-VEGF medication, which helps control abnormal blood vessel growth. Surgery may be needed in severe cases," Dr Goh said.
She added that even when ROP has been successfully treated and the retina is stable, children born prematurely remain at higher risk of other vision problems, including short-sightedness, squint and amblyopia, commonly known as lazy eye.
"These children may continue to have visual problems because their eyes and visual system are still developing. Regular eye checks during early childhood are therefore important," she said.
She also stressed the importance of detecting and treating these problems early, particularly during the first five years of life, when the visual system is developing rapidly.
She said early treatment can help prevent amblyopia and give children the best opportunity to develop good vision.
She noted that supporting a child's development goes beyond medical care.
"Interaction between parents and children, stimulation and quality family time are also important.
"Every child is precious, so parents should spend more quality time together, engaging in outdoor activities, playing and doing things as a family," she advised.