This article is more than 5 years old. Information may no longer be current.
BLOG: ROP — Advances in neonatal care yield more human suffering in the developing world
Click Here to Manage Email Alerts
This issue’s cover story focuses on the evolving role of anti-VEGF drugs for the treatment of retinopathy of prematurity. In the developed world, these compounds hold immense promise, with cautions, for better control of a disease that used to uniformly blind children born before 31 weeks of gestation or at less than 1,250 g weight.
But in the developing world, ROP plays out in a very different way. Many countries have a health care system that has learned just enough to keep premature babies alive but not enough to prevent ROP. Oxygen use is either uncontrolled or, worse, pulsed in a manner that actually stimulates neovascularization. In the former Soviet country of Armenia, where I have done volunteer work for 20 years, and whose health system is relatively advanced compared with most newly independent states, the burden of caring for children blinded by ROP can be devastating for a family. It is agonizing to see the scores of children in schools for the blind who live in developing countries with limited resources for computer systems to teach and opportunities for employment.
As usual, where there is hope, there are also challenges. At one maternity hospital in Armenia, the Armenian EyeCare Project, a Californian nonprofit started by ophthalmologist Roger Ohanesian (my partner in practice but no relation to me), has installed an extremely effective telemedicine program. The program uses a sophisticated fundus camera for preemies, generously donated by Clarity Medical Systems, which is known best as the manufacturer of the Holos intraoperative aberrometer but also makes some of the world’s best retinal imaging technologies. Local doctors in Armenia are now able to obtain widefield images of the fundus of preemies and collaborate with U.S.-based retina specialists like volunteer Tom Lee of the USC School of Medicine. With this advance, local neonatologists can monitor for disease progression and call upon the country’s limited number of retina specialists for intervention when necessary.
Tears of pity we used to shed for children who became unnecessarily blind are now giving way to tears of joy as we see properly treated babies turn into perfectly sighted children.
But the developing world is big. Our specialty has a responsibility to help guide the underprivileged nations in understanding the judicious use of oxygen supplementation. We need simple protocols for preventing and treating ROP in those preemies at the highest risk. The human cost of doing otherwise is unbearable to consider.
Disclosure: Hovanesian reports no relevant financial disclosures.