Learning to See

By Lily Tung Crystal

In early May, Rosa and Javier Lupercio welcomed their second child Aalo into the world. It was a joyous occasion, except that he was 14 weeks early. His first few weeks of life at California Pacific Medical Center’s Neonatal Intensive Care Unit were excruciating for his parents. Aalo was put on a ventilator and underwent heart surgery.

Then at 2 months, Aalo finally started to stabilize, gaining weight, and eating and breathing on his own. The Lupercios were about to let out a sigh of relief, but then came another blow. “The doctors told us that Aalo had retinopathy of prematurity,” recalls Rosa. “We were really scared. I didn’t
even know babies could come out that early, and now they were saying that he may go blind.”

Retinopathy of prematurity, or ROP, is an eye disease that affects premature infants. Blood vessels in the retina develop abnormally, potentially causing serious eye conditions, like crossed eyes and severe nearsightedness. ROP is also the leading cause of blindness in children.

Cause and Risk

It takes 36 to 40 weeks for a fetus to fully develop the blood vessels that supply oxygen to the retina. “When babies are born early, their immature retina enters a completely different environment than it had in the womb,” explains J. Michael Jumper, M.D., retina service chief, department of ophthalmology at CPMC. “That shock changes retinal development, putting the eye at risk for abnormal blood vessel growth, bleeding and scarring.” When vessels scar, they often contract, which could lead them to pull and detach the retina.

“ROP has many risk factors,” says William Good, M.D., pediatric ophthalmologist at CPMC and senior scientist at Smith-Kettlewell Eye Research Institute. “The smaller, sicker, and more premature newborns are, the more likely they will get ROP.”

Babies born before 30 weeks of gestation are especially at risk. Nearly 70 percent of preemies who weigh below 2.75 pounds get ROP. If a newborn weighs less than 1.1 pounds, he or she has a 90 percent chance of developing the disease.

In Good Hands

The positive news is that with early diagnosis and treatment, most children with ROP keep their eyesight. Aalo Lupercio is one of nearly 200 preemies a year who are screened for ROP at CPMC. A very small number of these babies are diagnosed and require intervention.

In those cases, doctors use laser treatment to destroy the retina cells that trigger abnormal blood vessel growth. If that doesn’t stop the progression, a surgeon goes in to decrease detachment of the retina.

In Aalo’s case, doctors are taking a wait-and-see approach before they prescribe laser treatment. Rosa and Javier remain optimistic. “I feel like I’m in the best hands possible,” Rosa insists. “The doctors and nurses here really care about their patients. And I hear Dr. Good is an amazing eye doctor.”

The CPMC staff is doing its best to ensure that every baby has a good start. “It’s been years since we’ve had a baby who lost his vision,” explains Aalo’s neonatologist Terri Slagle, M.D., clinical director of the nurseries at CPMC. Aalo’s chances for good eyesight are extremely high. The key is that we’re lucky to have two phenomenal retinal specialists here. Dr. Good and Dr. Jumper are national treasures.”

Vision for the Future

Because doctors at CPMC are at the forefront of ophthalmological care, more than 90 percent of the babies treated there are cured of ROP. “A premature newborn has a better chance now than ever before because of the advanced therapies we have available to us,” assures Jumper. “Despite ROP being a scary and serious condition, the chance of blindness in both eyes is extremely low.”

That’s thanks in large part to the work of Good, one of the world’s ROP experts, whom colleagues call “the guru of ROP.” Good is spearheading a study at the National Institutes of Health that researches methods to prevent and treat ROP.

CPMC’s commitment to care and research has helped change the lives of premature babies everywhere, and Rosa wishes the same for Aalo. “I hope that Aalo will see, play sports, and grow up to do anything he wants to do,” she muses.

For more information on pediatric ophthalmology services, visit cpmc.org/pediatrics.