The other day one of my 8-year-old twins told me she was having trouble seeing. Like many things, eye problems were something I thought we had left behind long ago.
“Like how?” I asked. “Are you having trouble seeing the board at school?”
“No,” she said. “When I’m reading, it gets all blurry.” That was about all the information I was going to get out of her.
My girls were born at 31 weeks, and we were aware that vision problems were not uncommon in preemies. They had been examined in the NICU, again at three months with the horrible device that had to hold their eyelids open, and again at one year (no horrible device necessary). Their blood vessels were growing appropriately, meaning they were not really at risk for retinopathy of prematurity, or ROP. Whew!
We’re at the age where it’s hard to tell if things that come up are related to their prematurity or to their genetic makeup. When they entered occupational therapy last summer at age 7, we were told that while many preemies end up in OT, so do plenty of term kids. I don’t have the best vision, so maybe this is just another trait she got from me, like her brown curly hair or her love of Netflix.
I’m concerned about her self-described farsightedness, meaning she claims she can see the board at school but has trouble reading her book at her desk. I’m nearsighted and can barely see past my own hand if I don’t have my glasses or contacts. And there’s also the small issue of whether or not there’s even a problem at all. My girls tend to…exaggerate.
Whether her issue is hereditary or a result of prematurity will have to wait until our next well check, but in the meantime, we rounded up some of the most common eye issues in preemies.
Retinopathy of Prematurity (ROP)
Retinopathy of Prematurity, referred to as ROP, is likely the most common eye issue is preemies, particularly those weighing less and 2 lbs, 12 oz. The condition, caused by abnormal blood vessel growth, usually in both eyes, can lead to life long vision problems and even blindness.
The eye’s blood vessels begin from the optic nerve and grow gradually around the eye. For babies born too soon, the blood vessels have not finished growing, so close monitoring is necessary to ensure proper growth. Your baby will likely receive their first visit from the eye doctor while still in the NICU. My girls also had appointments at three months and one year, where they were cleared of any abnormalities.
With severe ROP, the abnormal blood vessel growth can cause the retina to partially or fully detach, causing vision loss. Severe cases may require surgery to correct.
ROP may also cause various other eye conditions:
- Myopia, or near-sightedness.
- Strabismus. Also referred to as “cross-eyed,” one or both eyes may turn in or out. Strabismus can be corrected with glasses, or surgery on the eye muscles may be necessary in some cases. (See below for more info on strabismus.)
- Astigmatism. With an astigmatism, the cornea is asymmetrical, making it hard to focus. Astigmatism can be corrected with special lenses.
- Amblyopia. Also known as “lazy eye,” Amblyopia occurs when one eye is stronger than the other, so the brain decides to communicate with that eye, leaving the weaker eye to drift. Amblyopia is often treated by patching the “good” eye, forcing the brain to use the “bad” eye. Many people with amblyopia will also need glasses.
Strabismus is caused when the eye muscles that surround and control the eye don’t work together. It’s thought that a preemie’s brain is not developed enough to control eye muscles, causing one or both to point in different directions. While sometimes caused by ROP, strabismus can also occur from brain or nerve disorders, brain bleeds, cerebral palsy, developmental delays, or even genetics.
Strabismus can also lead to amblyopia, or “lazy eye.” When they eyes point in different directions, the brain perceives two different images, but will tend to concentrate on the image from the straighter eye. The crossed eye may even lose its vision, also causing lack of depth perception.
Find out more
If you are concerned about your preemie’s vision or eye development, talk to your pediatrician or health care team. Regular eye exams may be necessary to ensure your baby’s eyes are developing appropriately.
For more information on ROP and strabismus, visit these resources: