A Controlled Clinical Trial of Light and Retinopathy of Prematurity

Seiberth, V.; Linderkamp, Otwin; Knorz, Michael C.; Liesenhoff, H

doi:10.1016/s0002-9394(14)75801-5

Cited by 45 publications

(27 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is not yet known whether blue-light radiances of 0.7-1.5 mWcm À2 sr À1 can cause acute or chronic effects on vision in neonates, although there is evidence that the retina of the preterm infant is more vulnerable to photochemical damage than the adult retina and that retinopathy of prematurity commences in the areas of the retina receiving the highest light dose (15). Despite the fact that reduction in ambient light exposure does not alter the incidence of retinopathy of prematurity (7,8) clinicians must be meticulous in protecting the eyes of extreme preterm infants against all forms of light energy, including phototherapy.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Do phototherapy hoods really protect the neonate?

Ostrowski¹

2000

SPAE

View full text Add to dashboard Cite

Nursing and medical staff must ensure meticulous care in the positioning of infants, so that the caudal edge of the shadow cast by the hood is always at least 30 mm inferior to the infants' lower eyelids. The vulnerability of the neonatal retina and the relatively high levels of blue-light radiance visible from within the shadow of the hood may make it advisable to use more effective eye protection. Triple phototherapy using lamps at the foot-end of the incubator is clearly hazardous and should not be carried out unless the infant's eyes are protected by eye-patches.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, in a recent study attempts to eliminate retinopathy of prematurity by decreasing ambient light were unsuccessful (7). Furthermore, a study randomizing infants to eye-patching or exposure to ambient light showed no difference in incidence of retinopathy of prematurity (8).…”

Section: Methodsmentioning

confidence: 99%

Do phototherapy hoods really protect the neonate?

Ostrowski¹

2000

SPAE

View full text Add to dashboard Cite

show abstract

“…The absence of any recognisable impact of ambient light exposure on the incidence of ROP also indirectly refutes the importance of light-generated free radicals. [12,13] Retinal changes in response to alterations in VEGF levels may or may not occur within a framework of free radical induced cell damage.…”

Section: Pathophysiologymentioning

confidence: 99%

“…[31] Several studies failed to provide a definitive answer to this hypothesis. [12,[32][33][34][35] Each study had ≥1 methodological flaws which limited the conclusions. In theory, light, like oxygen, generates retinal free radicals which might be involved in the pathogenesis of ROP.…”

Section: Management Of Retinopathy Of Prematurity (Rop)mentioning

confidence: 99%

The Management of Retinopathy of Prematurity

Reynolds

2001

Paediatric Drugs

View full text Add to dashboard Cite

Retinopathy of prematurity (ROP) is a major problem in both highly developed countries and countries with emerging technology. The incidence of ROP has been stable over the last 2 decades despite improvements in neonatology. Threshold ROP occurs in about 5% of premature infants in the US with birthweights <1.25kg. Despite treatment, a sizable minority will become blind (up to 20 to 30%). The pathophysiology of ROP can be separated into 2 phases. Phase I is hyperoxia-vasocessation. Phase II is hypoxia-vasoproliferation. The former occurs immediately following premature birth. The provision of supplemental oxygen causes retinal hyperoxia, a down regulation of vascular endothelial growth factor (VEGF) and a consequent cessation of normal retinal vascularisation. Systemic factors and increasing retinal metabolic demands cause a shift to phase II when a relative retinal hypoxia develops. This hypoxia stimulates VEGF production, leading to renewed vascularisation. This can be the resumption of normal vascularisation or abnormal neovascularisation, depending on local retinal responses. The management of ROP begins with a reliable evidence-based screening protocol. All interested parties must cooperate in developing and implementing foolproof screening protocols. Hospital officials, nursery personnel, neonatologists and ophthalmologists all have areas of responsibility in ensuring adequate screening. ROP management involves prevention, interdiction and correction. Prevention includes: adequate prenatal care which minimises premature birth, and appropriate systemic intensive care which lessens the tissue hyperoxia/hypoxia swings. Pharmacological vitamin E supplementation has largely been abandoned and ambient light reduction has been shown to be ineffective. The value of inositol supplementation and angiogenesis inhibitors in preventing ROP is presently under investigation. Interdiction concentrates on ablation of the peripheral avascular retina, thus dramatically decreasing VEGF production. Both cryotherapy and laser photocoagulation are effective; however, unfortunately, poor outcomes persist despite treatment. Supplemental oxygen administration has so far proven ineffective in limiting ROP progression. Finally, correction focuses on vitrectomy/retinal detachment repair. While anatomically successful, this procedure is often unsuccessful in terms of restoration of vision (<5% success rate). In conclusion, despite improvements in neonatology, ROP, potentially leading to blindness, continues to be a common problem associated with prematurity. Future management success must concentrate on discovering new modes of treatment, especially prevention.

show abstract

“…C linical studies conducted to date have yielded conflicting results on the effects of light on retinopathy of prematurity (ROP). [1][2][3][4] Phelps and Watts 5 performed a Cochrane Review and meta-analysis, reviewing all papers published to date (and included the present study as ''in progress''). They concluded that it is unlikely that the ambient luminosity affects the incidence of ROP, but stressed the large confidence intervals in the combined data, which were due to the small number of threshold or pre-threshold diseases.…”

mentioning

confidence: 99%