About Retinopathy of Prematurity

[Ms. Kathy]

One of my favorite classes was the preschool class I had of children with visual impairments who were born premature.

This condition used to be called--get ready for a mouthful--retrolentalfibroplasia.

As the name implies, it has to do with the retina of children born significantly before their due date.

Oops! I'm about to time out so I will post more info about my babies later. Meanwhile, feel free to post info, discussions, questions, etc., here about our kids with ROP.

[Liz]

Why does this happen?

[Ms. Kathy]

ROP happens in premature babies because the cells in the back of the eyes start growing haywire because of excessive oxygen needed to save their lives.

The Association for Retinopathy of Prematurity and Related Diseases has a wonderful web site at (http://ropard.org/) with more detailed information, links, and support. They will send e-newsletters concerning the latest news with registration at the site.

[Ms. Kathy]

Health Calendar
TODAY
Source: www.detnews.com

Genetics A Key Factor In Premature Infants' Devastating Eye Disease
Genetics play a major role in predisposing infants to retinopathy of prematurity (ROP), a disease prevalent in premature infants that disrupts normal blood vessel development of the retina and can lead to blindness, researchers at Yale School of Medicine report in the November issue of Pediatrics.
Source: www.sciencedaily.com
posted by manjerrs for center fitness at 10:30 AM

[Ms. Kathy]

A three-dimensional miracle
[This is from a blog of a wonderful site called Dad Bloggers: Dad's for Life at www.dadbloggers.com/index.php/weblog/comments/a_three_dimensional_miracle/]

Submitted by Jeremy on Nov 30, 2006
“Jordyn, can you see this? What animals do you see?” the eye specialist asked my little girl yesterday morning.

A pause. I was holding my breath. I’d bet money Gem was, too.

“A cat!” and the doctor looked at us both as if he had performed a magic trick.

Maybe not a magic trick.

More like a miracle.

My wife and I have been fighting one of the most important battles in our parenting lives; the fight to save our daughter’s sight. We will take any magic tricks or miracles that help her.

My little girl, my adorable, intelligent, absolutely beautiful little girl, is lucky to be able to see at all. She (and her twin brother) was born almost 2.5 months early. Both of my Okapis had something called Retinopathy of Prematurity, but Elijah’s wasn’t bad at all and corrected itself. Jordyn, however, needed surgery. Eye laser surgery at 8 weeks old. In both of her eyes.

The doctor yesterday said he could see the burn marks on her retina, the little holes they “drilled” with the laser to reduce the pressure on her retinas so they wouldn’t detach. Even though we have never, and will never, be able to see them, the idea that she has burn marks from that surgery on her retinas shakes me to my core.

But even laser surgery on both eyes at 2 months was not enough to save her vision. Her right eye was significantly worse than her left and before she could even walk we had to patch her “good” eye to try and strengthen her weaker one. Her brain was ignoring the signals that eye was sending and if that continued, she would lose sight in that eye. The patching forced her brain to pay attention. It also became the worst hour of the day for Gem and I because Jordyn didn’t want the patch so she would rip it off her face every chance she got. Fortunately, we found a place called Patch Pals (http://www.patchpals.com) and they make patches that fit over glasses, that don’t stick to her face, that have adorable little designs on them, giving Jordyn a chance to choose which patch she wants to wear (ballet shoes, the sun, a cat, puppy dog, panda bear, etc.). They are essentially for my little girl, a unique accessory, like a bracelet is for other girls, except no one else she knows wears a patch.

She has been wearing patches for over two years. For two years we’ve been visiting our eye specialist every three months to have her eyes checked out. For one long stretch she had to wear a patch for 8 hours a day. Now we’re down to six – short enough so she doesn’t have to wear it during school or other classes. She has made enormous improvement, but most of her gains in vision are not visible to us. Until yesterday.

The last time we visited our eye specialist, Jordyn was given the same test she received yesterday. I’m sure you’ve seen those pictures of colored lines and if you look at it carefully enough you can see that there is a 3-d looking image inside of it? It was all the craze a few years ago. That is the test the doctor gave her. Last time, she was unable to see anything. She had no 3-D vision and Gem and I were concerned.

“Don’t worry,” he had said. “Her brain will learn another way to see three dimensionally.” I didn’t NOT believe him. I just couldn’t envision how that happens.

When she saw a cat, I believed. I believed her brain was growing, learning new ways to ensure my little girl can see – despite all she has been through.

“Whatever you guys are doing, keep it up. You’re doing great! Come back in six months,” he told us instead of the usual three months.

I believed that everything we have been doing, forcing her to wear her patches every single day for the past two years has been making a difference, has been the difference between her seeing and not seeing.

When we got to the elevator after leaving his office, I gave my wife a high-five. We don’t talk about our fight much anymore, but neither of us has lost the determination to win this, to give our little girl every chance possible to see how beautiful and wonderful she is, to see all the people that love her.

“I don’t know whether to scream in excitement or to cry,” my wife said, her voice full of pride, of satisfaction, of relief.

I feel the same way.

[Ms. Kathy]

Genetics A Key Factor In Premature Infants' Devastating Eye Disease
Source: www.sciencedaily.com/releases/2006/11/061122150336.htm

Genetics play a major role in predisposing infants to retinopathy of prematurity (ROP), a disease prevalent in premature infants that disrupts normal blood vessel development of the retina and can lead to blindness, researchers at Yale School of Medicine report in the November issue of Pediatrics.

"This is the first definitive study to show that genetic factors are a significant component of ROP, and to quantify the extent of that genetic contribution," said lead author Vineet Bhandari, M.D., assistant professor of pediatrics at Yale School of Medicine.

ROP is most prevalent and severe in extremely low birth weight newborns with an overall incidence estimated to be as high as 68 percent among those born at less than 1,251 grams (2.75 pounds), and 93 percent in those born less than 750 grams (1.6 pounds). Despite early detection and intervention, ROP may lead to retinal detachment and blindness. In an attempt to treat ROP, researchers have sought significant factors, such as too much oxygen, that contribute to the disease. The Yale team hypothesized that there was a strong genetic connection involved in developing ROP.

They looked at contributing factors and outcomes for ROP within 200 twin pairs born at 32 weeks gestation or less. Study participants were from Yale, the Karolinska Institute in Sweden and the University of Connecticut. These 200 twin pairs had a mean gestational age and birth weight of 29 weeks and 1,332 grams (2.9 pounds), respectively.

"Our analyses showed that gestational age and duration of supplemental oxygen were the significant independent contributing factors for ROP," said Bhandari. "Once significant non-genetic co-factors for ROP were identified, we calculated the genetic susceptibility and determined that 70 percent of the contribution to ROP was the result of genetic factors alone."

"The magnitude to which genetic factors contribute to this major cause of infant morbidity accentuates the need for a shift in the paradigm utilized to identify and treat this disease process," Bhandari added. "It is possible that a dual therapy for ROP aimed at limiting potential environmental risk factors and identifying and targeting specific genetic factors may become the model for future intervention."

Other authors on the study included Matthew J. Bizzarro, M.D., Laura R. Ment, M.D., of the Department of Pediatrics at Yale; Jeffrey R. Gruen, M.D., of the Departments of Pediatrics and Genetics; Heping Zhang and Rui Feng of the Department of Epidemiology and Public Health at Yale; Naveed Hussain, M.D., of the University of Connecticut Health Center; and Baldvin Jonsson, M.D., of the Karolinska Institute.

Citation: Pediatrics, 118: 1858-1863 (November 2006)

[Ms. Kathy]

Breaking Studies: Masimo SET Pulse Oximetry Technology Shown to Be Most Effective During Neonatal Resuscitation and Valuable in Caring for Extremely Low Birth Weight Infants
2007-05-09 20:34:31 -
Source Link: PR.com Inside--News and Free PR www.pr-inside.com/breaking-studies-masimo-set-pulse-oximetry-r119598.htm


IRVINE, Calif., May 9 /PRNewswire/ -- Masimo, the inventor of Pulse CO-Oximetry and Read-Through Motion and Low Perfusion pulse oximetry, reported that three new independent studies presented at the Pediatric Academic Societies' (PAS) Annual Meeting in Toronto, Canada this week reinforced the clinical accuracy and reliability of Masimo SET pulse oximetry under the most difficult clinical conditions, including neonatal resuscitation and heart rate monitoring of extremely low birth weight infants. In one study, Masimo SET was shown to be more than three times faster than competing technologies in its ability to reach a stable and adequate SpO2 reading during neonatal resuscitation(1).

In the study entitled Avoiding Hyperoxemia during Neonatal Resuscitation: Time to Response of Different SpO2 Monitors a team of neonatologists from hospitals in Columbia and New Jersey headed by Herando Baquero, Ramiro Alviz, and Augusto Sola performed a prospective observational analysis of 24 newborns who received resuscitation in unstable conditions in the delivery room and NICU to determine whether if SpO2 can be measured reliably and if the time to stable readings is different between different monitors. The researchers' specific interest was in preventing oxygen overdose or hyperoxemia, which has been linked to neonatal eye damage and even blindness from retinopathy of prematurity (ROP). Researchers compared readings from a Masimo SET Radical to those from two other pulse oximeters and found that the Masimo unit was able to reach a stable oxygen saturation more than three times as fast as the next best pulse oximeter tested.

As a result of this study, the researchers noted that "adequate and clinically useful reading of SpO2 is possible during newborn resuscitation and that "the time to stable and adequate reading is significantly different between SpO2 monitors"-with Masimo shown to have by far the fastest response time. Researchers further concluded that "the SpO2 monitor with the fastest response time would allow for more rapid adjustments of FiO2 (oxygen) during resuscitation and avoid unnecessary exposure to hyperoxia."

In two other studies presented at the PAS meeting in Toronto, both performed by a team of neonatologists including Jennifer Dawson, Omar Kamlin, Colm O'Donnell, Peter Davis and Colin Morley at Royal Women's Hospital in Melbourne, Australia, the researchers set out to determine if the heartrate from a Masimo SET pulse oximeter was reliable enough to guide treatment of extremely low birth weight infants in the delivery room(2,3). The first study entitled How Accurate is Pulse Oximetry in Measuring the Heart Rate (HR) of Newly Born Infants? compared ECG and SpO2 heartrate data from 55 infants and found that on average, measurement of heart rate by Masimo SET matched ECG heartrate, with researchers noting that the Masimo SET showed the highest sensitivity in identifying infants requiring intervention with heartrates below 100 beats per minute.


In the second study, entitled Delivery Room Heart Rate Measurements of Infants Born at 24-28 Weeks Gestation, the researchers noted that although pulse oximetry is widely used to measure oxygen saturation and heart rate in the delivery room, there were no reports about the range of heart rate during neonatal transition of extremely low birth weight infants, adding that heart rate "is an important indicator of the need for, and the response to resuscitation in newly born infants."

Because of this, researchers analyzed heart rate data obtained from 26 premature births using Masimo SET pulse oximeters and determined that "it is feasible to measure heart rate by pulse oximetry in extremely low birth rate infants in the delivery room. Continuous heart rate measured by pulse oximetry may be valuable in guiding the need for and response to resuscitative interventions in the DR and warrants further investigation."

Joe E. Kiani, Chairman and CEO of Masimo stated: "We are very happy to see that researchers around the world continue to use our technology to improve process of care, positively impacting the lives of the most vulnerable patients in the most difficult clinical conditions. The ability to provide clinicians with the information they need to make a difference in the lives of neonatal patients continues to be a great source of pride for the entire Masimo team. Our commitment to neonatal and infant monitoring is evidenced by innovations like our Newborn sensor designed for newborn resuscitation and examination and our Blue sensor, which is specially designed to monitor cyanotic babies with very low oxygen saturation and children with congenital heart defects."

About Masimo
Masimo develops innovative monitoring technologies that significantly improve patient care-helping solve "unsolvable" problems. In 1995, the company debuted Read-Through Motion and Low Perfusion pulse oximetry, known as SET and with it virtually eliminated false alarms and increased pulse oximetry's ability to detect life-threatening events. More than 100 independent clinical studies have confirmed that Masimo SET technology allows clinicians to accurately monitor blood oxygen saturation in critical care situations-establishing the technology as the "gold standard" pulse oximetry and substantially contributing to improved patient outcomes. In 2005 Masimo introduced Masimo Rainbow SET Pulse CO-Oximetry, which, for the first time, noninvasively monitors the level of carbon monoxide and methemoglobin in the blood, allowing early detection and treatment of potentially life-threatening conditions. Masimo, founded in 1989, has the mission of "Improving Patient Outcomes and Reducing Cost of Care by Taking Noninvasive Monitoring to New Sites and Applications." Additional information about Masimo and its products may be found at www.masimo.com/.

(1) Avoiding Hyperoxemia during Neonatal Resuscitation: Time to Response of Different SpO2 Monitors. Hernando Baquero, Ramiro Alviz, Augusto Sola. Neonatology, Universidad Norte, Barranquilla, Atlantico, Colombia; Neonatology, MACSA - Clinica del Mar, Barranquilla, Atlantico, Colombia; Neonatology, Mid Atlantic Neonatology Associates and Morristown Memorial Hospital, Morristown, NJ.
(2) Delivery Room Heart Rate Measurements of Infants Born at 24-28 Weeks Gestation. Jennifer A. Dawson, C. Omar F. Kamlin, Colm P.F. O'Donnell, Peter G. Davis, Colin J. Morley. Neonatal Services, Royal Women's Hospital, Melbourne, Australia.
(3) How Accurate Is Pulse Oximetry in Measuring the Heart Rate (HR) of Newly Born Infants? C. Omar F. Kamlin, Jennifer A. Dawson, Colm P.F. O'Donnell, Jasbir Sekhon, Colin J. Morley, Peter G. Davis. Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.

Contact:
Tom McCall
Masimo Corporation
949-297-7075

Masimo, SET, Signal Extraction Technology, Radical, Radical-7, Rad57, APOD, and Improving Outcomes and Reducing Cost of Care by Taking Noninvasive Monitoring to New Sites and Applications are registered trademarks of Masimo Corp. ARM, Acoustic Respiratory Monitoring, BiFi, Rainbow, SpCO, SpMet, SpHb and Pulse CO-Oximeter are trademarks of Masimo Corp.

Source: Masimo

Press release: www.pr-inside.com

[Ms. Kathy]

Saving preemies' sight
By Ryan Ori Monday, May 28 2007, 01:51 PM EDT
Source Link: Greater Paramus News and Lifestyle Magazine - Saving preemies' sight: www.paramuspost.com/article.php/20070524215148269

PREEMIES 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.


HIGH-TECH TOOL FOR PREMATURE BABIES "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."

---

Since the original post, I have found this video:

Eye examination of premature newborn children

[Ms. Kathy]

Astronomers predict the future health of unborn babies

Astrophysicists at the University of Sussex are using their statistical expertise to help save the lives of unborn babies.

Professor Andrew Liddle, Dr Rich Savage Dr Seb Oliver, Dr Pia Mukherjee and Dr David Parkinson are working with data from a recent clinical study of premature infants at Leeds Infirmary to spot genetic and demographic factors that may increase the risk of conditions such as chronic lung disease.

They will then use this information to build a statistical model that can be used to predict at-risk pregnancies, which will lead to doctors being able to apply pre-emptive treatment to reduce or prevent the conditions.

The joint project, which is funded by a Scientific and Technology Facilities Council grant, came about after Dr Savage was contacted by Professor Malcolm Levene, project co-investigator at Leeds Infirmary who personally knows Dr Savage.

Dr Savage says: "Astrophysicists have to use very advanced statistical techniques because we work with such difficult data. We analyse light from distant galaxies, which is often extremely faint. Because these techniques are so powerful, there are often other contexts in which they can be useful.

"The data in this case are so complex because the diseases can be caused by complicated and often subtle combinations of different factors. For example, if one smokes and is a certain age and has a certain set of genes then a given disease might be likely, but all three must be true. In this case, there'd be no single test one could do to determine the risk."

The Sussex scientists are using Bayesian statistical classification techniques to predict the predisposition of mother-baby pairs to four major disorders of prematurity (periventricular leukomalacia, chronic lung disease, retinopathy of prematurity and necrotizing enterocolitis) leading to permanent disability in later life. "Bayesian" refers to a particular type of statistics that can be particularly flexible for combining all pertinent information into a single analysis to get the best possible results.

Source: University of Sussex

This news is brought to you by PhysOrg.com
www.physorg.com/news102003123.html

[Ms. Kathy]

How fish oil could save a baby's sight
By FIONA MACRAE
Source Link: The Daily Mail www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=464177&in_page_id=1770

Fish oil supplements could save the sight of millions of pensioners and premature babies, doctors believe.

Research shows that omega 3 fatty acids, abundant in oily fish, can halve the damage to blood vessels in the retina - the light-sensitive tissue at the back of the eye.

Damage to retinal blood vessels, or retinopathy, is behind a range of conditions that can lead to loss of sight, including many cases of age-related macular degeneration, or AMD, the most common cause of blindness in the elderly.

More than 2,000 premature babies born in the UK each year are affected by retinopathy - and around 500 are blinded by it.

Research suggests that small changes in diet could have a huge effect in saving sight.

The study, carried out in mice, found that a small increase in the amount of omega 3 eaten was enough to almost halve the amount of blood vessel damage.

It is thought that the fatty acids, which are credited with a host of health benefits, quell the inflammation blamed for much of the damage to the blood vessels.

Researcher Dr Kip Connor, of Boston's Children's Hospital, said: "Our studies suggest that after initial loss, vessels regrew more quickly and efficiently in the omega 3-fed mice.

"This increased the oxygen supply to the retinal tissue, resulting in dampening the inflammatory 'alarm' signals that lead to pathologic vessel growth."

The study was published in the journal Nature Medicine. Fellow researcher Dr Lois Smith said the finding could benefit millions of pensioners and premature babies and may also prove important in staving off blindness linked to diabetes.

"We hope to translate this work to influence the outcome in patients," she said. "Our results suggest that increasing omega 3 fatty acid intake in premature infants may significantly decrease the occurrence of retinopathy of prematurity.

"This may also translate to AMD and diabetic retinopathy.

"If clinical trials find that supplementing with omega 3 is as effective at protecting humans against retinal disease, this costeffective-intervention could benefit millions-of people."

Clinical trials on premature babies, whose early birth means they do not glean as much omega 3 from their mothers as other newborns, and AMD patients are planned.

Other health benefits credited to omega 3 include staving off cancer and keeping high blood pressure at bay, slashing the risk of heart attack and stroke. The oils may also ward off Alzheimer's disease, protect against mental health problems and boost children's brain power.

Experts recommend that individuals take in 0.5g of omega 3 a day for optimum health - the equivalent of four meals a week of oily fish.

But, despite the health benefits, most people eat just a fifth of the recommended amount, with few eating oily fish, one of the best natural sources of omega 3.

Fish rich in omega 3 include mackerel, trout, herring, sardines, tuna and salmon. Plant sources include walnuts, flaxseed and canola oil. Some milk, eggs and margarine spreads are enriched with the nutrient which is also available as a supplement.

[Ms. Kathy]

Six-figure sum for girl left blind by birth defect
Source Link: Ham & High 24--Hamptead and High Express news on line (UK) www.hamhigh.co.uk/content/camden/hamhigh/news/story.aspx?brand=NorthLondon24&category=Newshamhigh&tBrand=northlondon24&tCategory=newshamhigh&itemid=WeED13%20Jul%202007%2012%3A50%3A32%3A470
[e-mail]
13 July 2007
Ed Thomas

A FAMILY from Belsize Park is set to receive a six-figure sum after their little girl was left blind from problems during her birth.

Mayah Revah, from the Russell Nurseries Estate on Haverstock Hill, was born three months premature at the Royal Free Hospital on January 20 1989 weighing barely a pound.

She had retinopathy of prematurity (ROP) which meant her eyes did not develop properly.

Mayah, who is now 18, was transferred to University College London Hospital (UCLH) where the condition initially went undetected, and despite surgery on May 8 1989, she has been left completely blind.

ROP was only just being understood by doctors at the time, but was treatable if caught early enough.

Mayah is now in line for a big payout to compensate for loss of earnings and the cost of her care, after the Health Authority agreed to settle her family's claim at the High Court this week.

"Damages are finally due to us - this is something we've been fighting for all her life," said Mayah's mum Larraine.

"We are only just getting there after all these years, but the figure has not been settled yet.

"It could be another few months before we hear how much we are paid. Experts are now making reports. It's a matter of what Mayah needs for her future."

The decision on Monday was made on the basis that, although no liability has been admitted, Mayah will receive 70 per cent of her total damages claim.

It was the family's lawyers' case that doctors at UCLH should have spotted the early signs of ROP, but failed to carry out fortnightly check ups as they should have done.

Robert Glancy QC, acting for the Revahs, argued that even when an eye check was done in April 1989, doctors still didn't discover the ROP.

He told Judge Michael Hardy QC that when Mayah was born ROP was on the "cusp of knowledge" following breakthrough research in the United States the year before.

But Sarah Vaughan Jones, for the North London Strategic Health Authority, in charge of UCLH, insisted that treatment of ROP was in its infancy, and the condition was so difficult to spot, medics could not be said to have been negligent.

Initially given an eye test shortly after her birth, Mayah didn't receive another one until April 26 1989, and Mr Glancy said that, although ROP probably wouldn't have been detected until April 19 1989, had she had an eye test then she may now have some vision.

Mayah was eventually allowed to go home with her mum and dad Benjamin in July 1989 and is now completely blind with no perception of light.

[e-mail]

[Ms. Kathy]

Fish Oil May Protect Preemies' Eyesight
Monday, July 09, 2007

Source Link: FoxNews.com www.foxnews.com/wires/2007Jul09/0,4670,HealthBeatPreemieBlindness,00.html
By LAURAN NEERGAARD, AP Medical Writer
ADVERTISEMENT
WASHINGTON —

Perhaps nowhere in the body is the adage "you are what you eat" so true as in your eyes, a link scientists are banking on in a novel bid to save premature babies' vision.

Doctors are about to begin testing whether fish oils could prevent a disease that can silently attack behind preemies' tiny eyelids, one that strikes about 16,000 U.S. infants a year and blinds hundreds.

It's part of research into a trio of apparently eye-healthy compounds that babies born too early miss absorbing from their mothers _ research gaining increasing attention as more and babies are born premature and at risk.

"We're trying to mimic what would happen in utero," explains Dr. Lois Smith, an opthalmologist at Children's Hospital Boston who is leading the work. "Rather than give drugs, we're doing replacement treatment."

Preventing the disease _ called retinopathy of prematurity, or ROP _ is a major goal, because there's no sure way to save vision once it strikes. Laser therapy decreases but doesn't eliminate the chance of blindness, and many babies who don't go blind still suffer serious damage.

It's not just an issue for preemies. The same abnormal growth of blood vessels behind ROP triggers two leading causes of blindness in adults: diabetic retinopathy and age-related macular degeneration. Already, scientists are studying if these omega-3 fatty acids _ the same kind touted for heart health _ could protect adult eyes, too.

Why might they? These diseases destroy the retina, the eye's innermost layer, which harbors a higher percentage of certain fats than other organs. Eat lots of salmon, rich in omega-3s, and your retina will show it. Eat mostly hamburgers, and your retina will harbor more of a different fatty acid, omega-6s. The retina's composition actually changes with diet.

Mothers pass omega-3s to their unborn children mostly during the third trimester, when the eyes develop most rapidly. Preemies not only miss out on some or all of that transfer, but omega-3s aren't added to the intravenous feeding that many require, either.

Premature babies have still forming retinas; blood vessels necessary to nourish them haven't finished growing. ROP forms when something spurs those blood vessels to grow abnormally _ too many form, and they leak.

But do omega-3s play a role? Smith and colleagues at Harvard and the National Eye Institute first turned to mice to find out.

They harmed the mice retinas in a way that mimics ROP, and then fed them different foods: Half ate the rodent version of a typical Western diet, high in omega-6s and low in omega-3s. Half ate the equivalent of a Japanese diet, with a 2 percent higher omega-3 content.

That simple change cut in half the retinal disease among the omega-3-nibbling mice, Smith reported last month in the journal Nature Medicine.

More intriguing, the omega-3s didn't just block bad blood vessels from forming. They also helped normal, healthy blood vessels grow. They appeared to work by blocking well-known inflammation-causing pathways in the body _ while mice fed more of the omega-6s experienced extra inflammation.

Now, Smith is about to begin a study in premature babies at her Boston hospital to see if adding omega-3s to their IV feedings _ feedings that today contain omega-6s instead _ decreases their risk of eye damage.

"This could be a very simple and safe treatment," says Dr. Rafael Ufret-Vincenty, a retina specialist at the University of Texas Southwestern Medical Center.

Indeed, omega-3s have long been known to be important for newborn brain development; they're in breast milk and are added to some formulas for older babies. When it comes to preemies' IV feeding, a version rich in omega-3s is available in Germany but hasn't spread to North America, says Dr. Sylvain Chemtob, an ROP specialist at Sainte-Justine University Health Centre in Montreal.

"It makes a lot of biological sense," he says.

These are the same fish oils sold as over-the-counter dietary supplements for heart health, and a nationwide study already is recruiting adults with macular degeneration to test if high doses could slow their vision loss.

For preemies, omega-3s aren't the only missing-from-mom player generating attention. A drug combination sold to treat hormone-deficient children grow taller is being studied, too _ a growth hormone called IGF-1 and a "binding protein" that helps regulate it.

Smith already knew babies with ROP lacked the growth hormone, but last month she and colleagues at Sweden's University of Goteborg reported they also have less binding protein than healthy babies. Studies in mice suggest that protein helps ROP-stricken retinas develop more normally, the Swedish team and University of Florida researchers reported, apparently by calling on stem cells to help build strong blood vessels.

Stay tuned: the Swedish scientists have begun a pilot study of the drug combo, Insmed Inc.'s Iplex, in preemies.

___

EDITOR'S NOTE _ Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

[Ms. Kathy]

dietHealth benefits of omega-3 fatty acids
18 September 2007
Source Link: di1w.centerofcontents.com/Health-benefits-of-omega-3-fatty-acids/

Health benefits of omega-3 fatty acids
Omega-3 fatty acids are now getting credit for health benefits in a surprising range of disease conditions.

Just to review a little, fats and fatty acids are said to be saturated if they have the maximum possible number of hydrogen atoms attached. In particular, a fatty acid is unsaturated if it has at least one double C-C bond on its main hydrocarbon chain. (An atom of hydrogen could potentially be attached there.) It is polyunsaturated if it has at least two. By definition, an omega-3 fatty acid is polyunsaturated, and in addition one of its double bonds occurs as close as possible to the end of the main chain that is opposite the carboxyl (COOH) group required in a fatty acid.

Curiously enough, this simple chemical property – rather than any more complicated chemical configuration – appears to be sufficient to confer a variety of health benefits on omega-3 fatty acids.

Perhaps the best-known benefit, for which there is\evidence in studies of particular (not all) omega-3 fatty acids, is related to coronary heart disease (e. g. atherosclerosis or “hardening of the arteries”). The omega-3 fatty acids most frequently involved are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

But recent research has encompassed many other disease conditions, for example, abnormal blood vessel growth that can cause blindness, such as that which may occur in retinopathy of premature infants, diabetic retinopathy, and “wet” age-related macular degeneration.

Omega-3 fatty acids protect eyes against retinopathy, study finds


The researchers studied the effect of the omega-3 fatty acids EPA and DHA, derived from fish, and the omega-6 fatty acid arachidonic acid on the loss of blood vessels, the re-growth of healthy vessels, and the growth of destructive abnormal vessels in a mouse model of oxygen-induced retinopathy. The retinopathy in the mouse shares many characteristics with retinopathy of prematurity (ROP) in humans. ROP is a disease of the eyes of prematurely born infants in which the retinal blood vessels increase in number and branch excessively, sometimes leading to bleeding or scarring. Infants who progress to a severe form of ROP are in danger of becoming permanently blind. There are also aspects of the disease process that may apply to diabetic retinopathy, a disease in which blood vessels swell and leak fluid or grow abnormally on the surface of the retina, and age-related macular degeneration (AMD), a disease of the macula, the part of the retina responsible for central vision, and a leading cause of vision loss in Americans 60 years of age and older.

Typical Western diets are lacking in omega-3 fatty acids, which are found mainly in shellfish and oily fish (e. g. salmon, sardines), and instead have a much higher percentage of omega-6 fatty acids. (In an omega-6 fatty acid, the only difference is that the first C-C double bond occurs farther from the end of the hydrocarbon chain that is opposite the carboxyl group. See these Wikipedia articles for more details: essential fatty acids, essential fatty acid interactions.) It turns out, oddly enough, that omega-6 fatty acids can have deleterious effects, just the opposite of omega-3 effects.


The researchers found that increasing omega-3 fatty acids and decreasing omega-6 fatty acids in the diet reduced the area of vessel loss that ultimately causes the growth of the abnormal vessels and blindness. Omega-6 fatty acid contributes to the growth of abnormal blood vessels in the retina.

To further test the apparent beneficial effect of omega-3 fatty acids, the researchers studied mice fed a diet modeled after a traditional Japanese diet (more omega-3 than omega-6 fatty acids) and mice fed a diet modeled after a traditional Western diet (lower amounts of omega-3 fatty acids). In addition, they studied mice genetically altered with a gene which mammals normally lack that converts omega-6 into omega-3 fatty acids. They found that the mice with higher amounts of omega-3 had a nearly 50 percent decrease in retinopathy.

Most importantly, this research identified a likely mechanism of action by which omega-3 fatty acids confer their benefits. The mechanism involves suppression of inflammation, especially involving the inflammatory cytokine TNF-á. In particular, this would apply to atherosclerosis, in which inflammation is generally regarded as a significant problem. Such anti-inflammatory properties, if indeed present, could account for the benefits of omega-3 fatty acids in other circumstances also. Another report on the same research describes this:

Can Blindness Be Prevented Through Diet?


Omega-3 fatty acids like DHA and EPA are thought to dampen inflammation in the body. …

The researchers demonstrated that the omega-3-based diet suppressed production of TNF-alpha, reducing the inflammatory response in the retina, whereas the omega-6-based diet increased TNF-alpha production. The retinas of omega-3-fed mice also had increased production of the anti-inflammatory compounds neuroprotectinD1, resolvinD1 and resolvinE1. These compounds, derived from omega-3 fatty acids, also potently protected against pathological vessel growth, and they were not detected in the retinas of mice fed the omega-6 diet.

Cancer is a rather more controversial case in connection with possible health benefits of omega-3 fatty acids. Many epidemiological studies have been done to try to identify cancer-protective effects of omega-3 in the diet, with varying results. Meta-analysis of such studies does not identify a conclusive connection. However, such studies are hampered by uncertainties about the actual diets consumed by participants. Additionally, a lot may depend on individual genetic factors. In animal studies it is possible to be much more quantitatively precise. For instance, we have this:

Omega-3 Fatty Acids May Help Slow Prostate Cancer Growth


The mice were fed either a diet high in omega-3 (ratio of omega-6 to omega-3 was 1:1) a diet low in omega 3 (ratio omega-6 to omega-3 was 20:1), or a diet high in omega-6 (ratio of omega-6 to omega-3 was 40:1). The scientists compared survival rates and weighed the animals’ prostates to measure tumor progression.

Mice with the tumor suppressor gene remained free of tumors and had 100 percent survival, regardless of diet. In mice with the gene defect, survival was 60 percent in animals on the high omega-3 diet, 10 percent in those on the low omega-3 diet and 0 percent in those on the high omega-6 diet.

“This suggests that if you have good genes, it may not matter too much what you eat,” said [senior researcher Yong Q.] Chen, a professor of cancer biology. “But if you have a gene that makes you susceptible to prostate cancer, your diet can tip the balance. Our data demonstrate the importance of gene-diet interactions, and that genetic cancer risk can be modified favorable by omega-3 PUFA.”

In a rather different direction, there has been a lot of suspicion, and some epidemiologial and experimental evidence, that omega-3 fatty acids and higher omega-3:omega-6 ratios have beneficial effects in connection with psychological and mood disorders. So it makes sense that omega-3 could be useful with the symptoms of agitation and depression associated with Alzheimer’s disease. It turns out that benefits may be significantly dependent on genetic factors related to the disease:

Omega-3 Supplements Can Help With Alzheimer’s Symptoms, Study Suggests


Omega-3 supplements can, in certain cases, help combat the depression and agitation symptoms associated with Alzheimer’s disease, according to a clinical study conducted at the Swedish medical university Karolinska Institutet.

A number of epidemiological studies have shown that eating fatty fish provides a certain degree of protection against Alzheimer’s and other dementia diseases–an effect often thought attributable to the omega-3 fatty acids it contains. Some studies also suggest that omega-3 can have a therapeutic effect on some psychiatric conditions.

The results were not straightforward, to put it mildly. There is a well-known susceptibility gene for Alzheimer’s, APOE4. Carriers of the gene experienced benefits for agitation symptoms, while non-carriers had benefits for depression symptoms!


There was no observable difference in therapeutic effect between the patients receiving the omega-3 and the placebo group. However, when the researchers took into account which of the patients carried the susceptibility gene APOE4 and which did not, an appreciable difference appeared. Carriers of the gene who had received active treatment responded positively to the omega-3 as regards agitation symptoms, while non-bearers of the gene showed an improvement in depressive symptoms.

[Ms. Kathy]

Neonatologists' Practices and Experiences in Arranging Retinopathy of Prematurity Screening Services
Alex R. Kemper, MD, MPH, MSa,b and David K. Wallace, MD, MPHb,c

a Program on Pediatric Health Services Research
b Departments of Pediatrics
c Ophthalmology, Duke University, Durham, North Carolina

BACKGROUND. Neonatologists play a central role in identifying infants who require screening for retinopathy of prematurity and in coordinating screening and treatment when necessary. No previous study has evaluated neonatologists' practices or experiences related to these activities.

METHODS. A national mail survey of a random sample of 300 neonatologists was conducted from September to November 2006.

RESULTS. The response rate was 62%. Nearly all (98%) of the respondents considered gestational age to identify infants for retinopathy of prematurity screening. However, only 19% used the currently recommended gestational age criterion of 30 weeks; instead, 6% used a lower, more-restrictive criterion, and 74% used a higher, more-inclusive criterion. Fewer respondents (77%) considered birth weight to identify infants for retinopathy of prematurity screening, most of whom (86%) used the current criterion of 1500 g. Although more than one half (67%) of the respondents reported that pediatric ophthalmologists usually screen infants for retinopathy of prematurity in their NICU, nearly one half (46%) reported that retinal specialists provide treatment. Some (36%) reported that they have been unable to transfer a child to a NICU of lower acuity or closer to the child's home because there are no specialists available there for retinopathy of prematurity screening. Some (34%) also reported that they have needed to delay discharge because outpatient follow-up for either screening or treatment of retinopathy of prematurity is not available near the family's home.

CONCLUSIONS. We found variations in how children are identified for retinopathy of prematurity screening and how screening and treatment are provided. Future research is needed to understand how these variations affect visual outcomes and costs of care. Such work must also consider the impact of regional pediatric eye care workforce shortages on retinopathy of prematurity screening and treatment strategies.

Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. 527-531 (doi:10.1542/peds.2007-0378) This Article
Source Link: Pediatrics: The Official Journal of the American Academy of Pediatrics pediatrics.aappublications.org/cgi/content/abstract/120/3/527

[Ms. Kathy]

Council of the Blind lights candle for those who can't see

By Bernie Altman
Fifty years ago, the lives of premature babies began to be saved by putting them in incubators and supplying them with oxygen. The technique worked. But health care professionals did not know at the time that the oxygen also damaged the retinas of the infants' eyes.

Linda Jacques and her twin sister Glenda, now 50, were premies, so they are alive today due to oxygen in their incubators. They've also had to live with the results. Each has a condition called prematurity retinopathy; they are legally blind.

Today, Linda says, the eyes of premature babies in incubators are covered and they're given shots to prevent retinopathy.

The Longview twins were told over and over that they would be blind by their twenties. Linda feels especially fortunate that the doctors were wrong by 20 years. She didn't start losing her sight, and was able to drive, until seven years ago. Now she's blind in one eye and is losing her sight in the other.

Linda is especially thrilled that she was able to care for her mother-in-law until she died of Alzheimer's disease and then her own mother until she died, all before the blindness started setting in. She was part of the Alzheimer's Disease support group for seven years. Later, she volunteered in the Hospice support group which had been a help to her own mother.

Those experiences, Linda said, inspired her to join the Lower Columbia Council of the Blind after her sight started going. Since January she has been president of the Council, which meets the second Saturday of each month from 1 to 3 p.m. in the Hemlock Court Senior Apartments behind the 15th Avenue Safeway in Longview.

The primary function of the group is support for people who are visually impaired or blind. Members regularly sell candy at Fibre Credit Union on Commerce. The proceeds help the group buy visual aids for a student to help him do his homework. This month they purchased a visual aid for a woman afflicted with macular degeneration.

"We do quite well," Linda said of the fund-raiser.

At the Cowlitz County Fair in August, council members hosted a blind awareness booth and invited visitors to take part in an activity that illustrated what it might be like to be bline.

One teen told Linda that day, "I will never make fun of blind people again."

"That made the whole four days worth it," said Linda.

Other activities include the white cane awareness day in spring and leadership conferences put on by the Washington Council of the Blind.

Linda said the council is just one of the support groups in her life -- she has lots of support from husband Dave and their three children and four grandchildren. She and Glenda have a fully sighted older sister Jeannie who drives them around town.

Linda finds another level of support at the Columbia Heights Assembly of God Church, where she belongs to the choir and book club. Pastor Kent Doehne lent her the Bible on tape.

"I'm having the most fun of my life," Linda said.