Retinopathy of Prematurity: Vision Loss and Eye Movement Issues

Vision problems

Hello, I would like to ask some questions.
Can retinopathy of prematurity cause a 30-degree visual field loss with -18.14 dB? When the eyes are not turned inward, there seems to be a section on the inner side where I cannot see well; moving objects seem to disappear, and I can only vaguely sense stronger light.
Is this the sensation of visual field loss? Does having this sensation indicate that the area of loss is larger and more severe? Is the overall narrowing of peripheral vision related to retinopathy of prematurity? For the nasal side, 30 degrees; temporal side, 80 degrees; superior side, 45 degrees; and inferior side, 60 degrees—does this count as severe? How large is the visual field that can be seen with these measurements? Does retinopathy of prematurity also cause nystagmus, resulting in rapid eye movements that are visibly apparent? Is the amplitude considered large? Can nystagmus worsen over time? Could it cause vision to deteriorate from 0.4 to 0.3? Is congenital nystagmus sometimes associated with a sensation of oscillopsia? Is it possible for nystagmus to involve both rotational and significant horizontal movements? In cases where both eyes exhibit severe nystagmus, can one eye be even more severely affected? (Both eyes have high frequency and rapid, noticeable movements.) Why does retinopathy of prematurity lead to retinal scarring? Is it true that the eye with atrophy may exhibit more severe and noticeable nystagmus than the other eye? Can ocular atrophy lead to high hyperopia? Is it possible for intraocular pressure to remain high after atrophy? If both eyes have high intraocular pressure, but the atrophic eye is higher (with white opacities on the cornea and intraocular pressure measured 20 mmHg higher than the other eye using a handheld tonometer), could this indicate a measurement error? I apologize for asking so many questions at once, and I appreciate your response.

Xin, 10~19 year old female. Ask Date: 2022/09/21

Dr. He Jianxian reply Ophthalmology

Retinopathy of prematurity (ROP) is a condition caused by the use of high concentrations of oxygen in premature infants, leading to retinal proliferation and traction.
Generally, it does not cause nystagmus unless the condition is severe and associated with visual impairment.
Nystagmus typically indicates poor visual acuity.
As for the term "ocular atrophy" you mentioned, it is unclear; the eye usually enters an atrophic phase when there is no vision, which seems inconsistent with your description.
The impact of the condition on the visual field depends on the extent and severity of the lesions.
The visual field range you mentioned does not appear to be very severe.
This is for your reference.
Dr.
He Jianxian, Ophthalmology, Nantou Hospital.

Reply Date: 2022/09/21

More Info

Retinopathy of Prematurity (ROP) is a significant concern in the field of pediatric ophthalmology, particularly for premature infants. This condition can lead to various visual impairments, including vision loss and issues with eye movement. Your questions touch on several critical aspects of ROP, and I will address them comprehensively.

Firstly, regarding your inquiry about a 30-degree visual field defect with a measurement of -18.14 dB, it is essential to understand that ROP can indeed lead to significant visual field loss. The degree of visual field loss can vary widely among individuals affected by ROP, depending on the severity of the disease and the extent of retinal damage. A defect in the visual field, especially if it is localized and associated with a sensation of missing objects or only perceiving bright lights, suggests that there may be substantial retinal involvement. This could indicate that the affected area of the retina is not functioning correctly, leading to the perception of a "blind spot" or scotoma.

The narrowing of peripheral vision you mentioned is also consistent with the effects of ROP. The condition can lead to scarring and retinal detachment, which can compromise the integrity of the visual field. The specific measurements you provided (30 degrees nasal, 80 degrees temporal, 45 degrees superior, and 60 degrees inferior) suggest a significant visual field restriction, which could be classified as severe depending on the context of the overall visual function.

Regarding your question about nystagmus (involuntary eye movements), it is indeed a common occurrence in individuals with ROP. Nystagmus can manifest as rapid, uncontrolled movements of the eyes, which may be horizontal, vertical, or rotational. The presence of nystagmus can complicate visual perception and may lead to a sensation of oscillopsia, where moving objects appear to bounce or blur. The severity of nystagmus can vary, and it is possible for one eye to exhibit more pronounced movements than the other, especially if there is asymmetrical retinal damage.

You also asked about the potential for nystagmus to worsen over time. While nystagmus can be stable in some individuals, it can also change in amplitude and frequency due to various factors, including changes in visual input or neurological conditions. The impact on visual acuity, such as a decline from 0.4 to 0.3, can occur if the underlying retinal condition deteriorates or if the nystagmus becomes more pronounced, affecting the ability to fixate on objects.

The scarring of the retina in ROP is primarily due to abnormal blood vessel growth and subsequent regression, leading to fibrous tissue formation. This scarring can disrupt the normal architecture of the retina and contribute to visual field loss and other complications. Additionally, the question of whether a shrunken eye (or microphthalmia) can lead to high hyperopia (farsightedness) is pertinent. A smaller eye can indeed result in a higher refractive error, as the optics of the eye are altered.

Regarding intraocular pressure (IOP), it is possible for an eye with structural abnormalities, such as those seen in ROP, to have elevated IOP. The presence of corneal opacities and other complications can further complicate the assessment of IOP. The use of different methods to measure IOP can yield varying results, and it is crucial to interpret these findings in the context of the overall ocular health of the patient.

In conclusion, ROP can lead to a complex array of visual impairments, including visual field defects, nystagmus, and changes in refractive error. It is essential to have a comprehensive evaluation by a pediatric ophthalmologist who can assess the extent of the condition and provide appropriate management strategies. Regular follow-ups and monitoring are crucial to address any changes in vision or eye health over time. If you have further questions or concerns, please do not hesitate to reach out for more information or clarification.

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