4. Stages of Retinopathy of Prematurity 1 Mildly abnormal blood vessel growth. 2 Blood vessel growth is moderately abnormal. 3 Blood vessel growth is severely abnormal. 4 Blood vessel growth is severely abnormal and there is a partially detached retina. 5 Total retinal detachment.

5. Retinopathy of Prematurity Normal Eye

6. What they see… Stage 4 Retinopathy of Prematurity Once the retina has partially detached, a shadow or curtain will come from the top or side of the eye until all vision is lost. During stage 5, the retina will completely detach and complete vision loss can be gradual or instantaneous.

7. What happens within the eye to cause Retinopathy of Prematurity? Blood vessels develop from the center of the retina and continue to form outwards. Baby Develops in the Womb (Week 30 of Pregnancy) If the blood vessels develop normally, the premature baby will not have Retinopathy of Prematurity. Baby Born Premature (Usually Anytime Before 36 Weeks) Abnormal vessels may bleed and become reabsorbed which may form bands that can pull up the retina. Baby Born Premature with Abnormal Blood Vessel Growth

8. Causes of Retinopathy of Prematurity Prematurity Low Birth Weight Administration and Duration of Oxygen All babies born before 30 weeks will be screened for Retinopathy of Prematurity. Usually occurs at an early gestational age (prematurity). Premature infants are given oxygen to survive, however the oxygen can cause the blood vessels to develop abnormally.

9. Treatments for Retinopathy of Prematurity Laser Therapy – burns away the edge (periphery) of the retina which has no normal blood vessels Cryotherapy – freezing temperatures touch spots on the edge (periphery) of the retina which may reduce the growth of abnormal vessels Scleral buckle – placing a silicone band around the eye and tightening it to keep the retina from detaching Vitrectomy – removing the vitreous fluid (fluid that give the eye its shape) and replacing it with saline allowing the retina to relax into the eye again Vitamin E Therapy – can be used to dissolve the abnormal blood vessels created by the oxygen given to infants Self Heal (Without Treatment) – sometimes the infants vision will develop normally just as it would inside the womb

10. Classroom Expectations and Accommodations Expectations Every student with Retinopathy of Prematurity will have a different level of severity, therefore, each student will need their own set of expectations in the classroom. Many students with Retinopathy of Prematurity may also have brain damage resulting in behavior and/or developmental delays. – Such delays need to be taken into consideration when deciding correct placement for students with Retinopathy of Prematurity. Accomadations Classroom – Bright lighting – Magnification for close work – Telescopes for distance viewing – Closed circuit television Physical Education – Team sports must be modified to ensure that other players or balls do not make contact the student when the student is not prepared for such contact

11. General Accommodations Orientation and Mobility An orientation and mobility specialist will need to schedule time with the student to ensure safety and best practices for travel and general mobility. Students with Retinopathy of Prematurity may benefit from an adult helping them get from one place to another within the school everyday. Early Intervention Sensory Stimulation – A multisensory teaching method may help an infant with Retinopathy of Prematurity Allowing the infant to hear, see and touch objects will create a better understanding Using real objects when playing with the infant or child may also help develop the senses. Many premature babies struggle with sensory problems, but early intervention has proven to be effective

12. References Levack, N., Stone, G., & Bishop, V. (1994). Low Vision: A resource guide with adaptations for students with visual impairments (2nd ed.). Austin, TX: Texas School for the Blind and Visually Impaired. Lueck, Amanda Hall (2004). Functional Vision: A Practitioner’s Guide to Evaluation and Intervention (Ed.). New York, NY: American Foundation for the Blind. Cassin, Barbara, & Rubin, Melvin L., MD (2012). Dictionary of Eye Terminology (6 th ed.). Gainesville, FL: Triad Publishing Company. National Eye Institute (October 2009). Retinopathy of Prematurity. Retrieved from http://www.nei.nih.gov/health/rop/rop.asp.http://www.nei.nih.gov/health/rop/rop.asp U.S. Library of Medicine (April 2013). Retinopathy of prematurity. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002585/.http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002585/