NICU and beyond: Eyecare for the infant, Part 2

It was a slow morning that Friday with a few cancellations. So, I was happy to see that the next patient had shown up, Baby Diya. She was listed as 6 months old. Babies are fun to examine, well, most of the times anyway.

Today she was accompanied by her parents, and grandfather. She was a precious baby, conceived by IVF after ten years of marriage. She was tiny and dressed in a pink dress. She was asleep as the parents sat down and started answering my queries.

No, they had no visual complaints. The child seemed to be looking at faces and smiling. They had come on the insistence of Dr. Minu, the neonatologist. Baby had been delivered by C section at 30 weeks and weighed 1.5 kg at birth. As per the protocol she had undergone an eye test of the retina for Retinopathy of Prematurity (ROP) by a retina doctor. After two weeks of screening when she was still in the NICU, the visiting retina doctor had told the parents that there was no ROP and that she was doing well. At the time of discharge, Dr. Minu had urged them to see a pediatric ophthalmologist and suggested my name. The parents were puzzled because the baby had no ROP. Dr. Minu had explained to them that premature children can develop other eye problems apart from ROP and that it was best that they do not neglect doing an eye test for Baby Divya.

I proceeded to examine Baby Divya who followed my targets briskly. When I dilated her with drops that are safe for use in an infant, she cried a bit. A cycloplegic refraction (which is the test for ‘power’ done in a child after instilling drops) revealed -3.00 Diopters in both eyes. Parents were worried but also relieved that they found out about this early. This would require close follow up and decision regarding whether to start spectacle correction right away. Additional precautions to prevent the power from increasing also need to be taken, such as complete avoidance of all screens and outdoor natural sunlight exposure daily.

Often premature infants are tested only for ROP and treated for the same or declared as ‘vascularized’ when the blood vessels have reached where they need to reach in the retina.

So, it was wonderful to find out that one astute neonatologist remembered that these children may have cerebral visual impairment, myopia, strabismus too which warrant examination by a pediatric ophthalmologist and referred the baby.

Well done Dr. Minu! Thank you for sharing in caring for these babies even after their leaving the NICU.