Dr. Lora Bineva, a specialist in ophthalmology at “Alexandrovska Hospital“, was awarded the Best Poster Award for a young scientist under 35 years of age at the 51st annual meeting of the European Society of Pediatric Ophthalmology (EPOS), held in Bucharest, Romania. The awards were won in competition with 74 international developments presented by leading European clinics and university centers. Dr. Bineva was awarded in the category “Retinal diseases and retinopathy of prematurity“ for the best poster “Assessment of visual functions in premature children“. Here is what Dr. Lora Bineva shared with FACT.
- Dr. Bineva, what motivated you to study the visual health of premature children and what is the most important message of your study?
- Premature children are a particularly vulnerable group - their visual system is exposed to factors from the neonatal period that can affect its structural and functional maturation. The most severe damage can occur with established retinopathy of prematurity, but it is not the only possible consequence of premature birth.
Our study included 59 children born before the 32nd week of gestation. It was found that visual impairments are common in both children with retinopathy of prematurity and those without it. This highlights the need for long-term ophthalmological follow-up of all premature infants.
- What is retinopathy of prematurity and why does it develop in some premature infants?
- Retinopathy of prematurity is a severe vascular disease of the immature retina that continues to be the leading cause of preventable blindness among premature infants.
After birth, changes in oxygen concentration and other factors related to the body's immaturity can disrupt the normal development of blood vessels in the retina. In some cases, abnormal vessels form, which can lead to hemorrhages, fibrous tissue formation, and retinal detachment. The risk is highest in children with a lower gestational age and birth weight, and the course of pregnancy, the neonatal period and concomitant diseases also play a role.
It is important to emphasize that retinopathy can have different severity. Many forms regress spontaneously, while severe forms require timely treatment. This is why screening and follow-up according to established criteria are of key importance.
- What are the main results of the study and what differences did you find between children with retinopathy and those without it?
- In the study, we compared two groups of premature children - with retinopathy of prematurity (33 children) and without established retinopathy (26 children). We analyzed three main indicators in each child: visual acuity, refractive errors, and deviations in orthoptic status (impairments in the joint work of both eyes).
When assessing visual acuity, a decrease was found in 10 out of 26 children without retinopathy and in 25 out of 33 children with retinopathy. Refractive errors were also common in both groups, with higher values observed in children with retinopathy: 22 children out of 33, compared to 13 out of 26 in children without retinopathy. Regarding oculomotor disorders, we found deviations in 12 out of 26 in the group without retinopathy and in 18 out of 33 in the group with retinopathy. These results show that the presence of retinopathy of prematurity is associated with a higher incidence of some visual disorders, but its absence does not exclude vision problems.
- Why can premature children have vision problems even when they are not diagnosed with retinopathy of prematurity?
- This is one of the most important questions raised by our study.
The visual system has a complex structure and development and does not depend solely on the condition of the retina.
Premature birth can affect the development of various eye structures, the visual pathways and the mechanisms by which both eyes work in sync. Therefore, even when the retina has developed without clinically significant retinopathy, a child may have nearsightedness, farsightedness, astigmatism, strabismus, reduced visual acuity, and other eye disorders. Some refractive errors and eye movement problems may develop later in life. A normal retinopathy screening result is very good news, but it does not represent a complete assessment of visual development.
- What are the most common vision problems in these children and how can they be recognized by parents?
- In our study, the most frequently detected vision disorders were refractive errors, specifically astigmatism and myopia. They are especially important in childhood, since the lack of proper correction can disrupt the normal development of the visual system and lead to amblyopia.
Parents may not always be able to recognize these disorders by the child's behavior, but possible signals are squinting, difficulty fixing objects. Sometimes reduced vision as a result of a refractive error can affect motor development and orientation in space - for example, the child may have difficulty reaching toys, judging distances, moving and walking. These manifestations are not specific only to visual problems, but in case of doubt it is important to evaluate visual function.
- How long should premature children be followed up and how often do they need to visit an ophthalmologist, even when the first examinations are normal?
- In premature children, the first examinations begin at 31 weeks of postmenstrual age for those born before 27 weeks of gestation and at 32 weeks of gestation for those born after 27 weeks of gestation. Depending on the finding, the ophthalmologist individualizes the schedule for subsequent examinations. In cases of normal examinations in the direction of retinopathy of prematurity, an examination is scheduled at 6 months of age. After that, a visit to the eye doctor's office is necessary once a year in case there are no complaints and visual disorders are detected.
- Can early diagnosis and timely treatment prevent permanent visual impairment?
- Yes, in most cases, early diagnosis and timely treatment prevent or limit permanent visual impairment.
In retinopathy of prematurity, timely treatment of the indicated cases can prevent progression to severe structural damage to the retina.
In refractive disorders, early prescription of appropriate optical correction provides a clear image on the retina and supports normal visual development.
In amblyopia ("lazy eye"), early detection is particularly important, since treatment is most effective during the period when the visual system is still developing.
Timely diagnosis of strabismus also allows for timely treatment and reduces the risk of development of amblyopia.
- Which conditions respond best when detected early?
- First of all, these are refractive disorders, in which appropriate optical correction can provide the necessary visual stimulus for the proper development of vision. Amblyopia is a condition characterized by reduced visual acuity as a result of an underdeveloped visual system in one eye (less often in both eyes). It occurs due to uncorrected refractive error, strabismus or due to visual deprivation (presence of ptosis, congenital cataract, etc.).
The earlier it is detected, the better the treatment options.
Strabismus also requires timely evaluation, as it can be associated with amblyopia and binocular vision disorders.
- What would you advise parents of children born prematurely who believe that since the baby does not have retinopathy, there is no reason for additional eye examinations?
- I would advise them not to miss preventive ophthalmological examinations, even when the child did not have retinopathy of prematurity or it has completely regressed. Parents should not wait for the child to start complaining, squinting or exhibiting visible difficulties. Young children may not always be able to express that they are not seeing well, and sometimes the problem affects only one eye and goes unnoticed.
The most important thing is to follow the recommendations of their ophthalmologist and to perceive vision monitoring as part of the overall development of the premature child.