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Retinopathy of Prematurity, Important Focus for Military Eye Doctors

Image of Health personnel conducting a morning assessment on an infant. Robyn Berryman, a neonatal nurse practitioner assigned to Naval Medical Center San Diego's Neonatal Intensive Care Unit (NICU), conducts a morning assessment on an infant in the hospital's NICU in September 2020. NMCSD's NICU specializes in the care of ill or premature newborn infants (Photo by: Navy Seaman Luke Cunningham, Naval Medical Center San Diego).

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Military medical professionals are often tasked with helping people who are in the physical prime of their lives: Otherwise fit young women and men who become injured or ill. But a small group of doctors and nurses tend to the most physically vulnerable of military family members - premature babies.

Among that group of infants, those born weighing under three pounds are at a significant risk of retinopathy of prematurity (ROP), a potentially blinding disease. Those at risk for ROP must be evaluated from a certain point in their development until the determined danger period passes.

ROP is an eye disorder caused by abnormal blood vessel growth in the light-sensitive part of the eyes (retina) of premature infants born before the 31st week of pregnancy (seven to 10 weeks early). In most cases, ROP resolves itself without treatment. But advanced ROP can cause permanent vision problems such as detached retinas, leading to blindness.

"We would call retinopathy of prematurity a high-risk, low-volume ophthalmology disease," said Navy Capt. (Dr.) Lisa Peterson, a pediatrician at the Naval Medical Center San Diego (NMCSD) in California and neonatology specialty advisor for the Navy's Bureau of Medicine and Surgery. "Generally, we're looking at babies born before 30 or 31 weeks of gestation. That population nationwide is about 1.4 or 1.5 percent of all births. ROP is definitely low-volume, but because of the severity, without adequate tracking and detection and treatment, it could lead to blindness."

Military Health System pediatric ophthalmologists and vision care service coordinators are increasingly paying attention to the risk of ROP because of a marked decrease in troops with eye injuries compared to the height of the wars in Iraq and Afghanistan. But perhaps there's an even more practical reason to stay on top of diseases affecting premature babies, or preemies.

"Soldiers are having babies left and right," said Army Col. (Dr.) Frank Valentin, pediatric ophthalmology chief at the Brooke Army Medical Center at Fort Sam Houston, Texas.

Numbers have gone down since the COVID-19 pandemic began, but in 2018, there were 36,000 births across the Department of Defense (DOD), he said. In 2017, there were 39,000; 43,000 in 2016; and 45,000 in 2015.

"If we take care of our military families with the highest quality of care, with excellence, our warriors can focus on the mission and worry less for their loved ones back home," he said.

Peterson agrees.

"For families, it's not simple," she said. "They not only have the stress of a new baby at home, but also a new baby who has multiple chronic conditions from being in the NICU and being extremely premature, and sometimes navigating a health system. And all of that can be difficult on its own."

But within MHS treatment facilities, the process works well, she added.

Parents holding their newborn child
Parents embrace their child at Naval Medical Center San Diego's (NMCSD) Neonatal Intensive Care Unit (NICU) in December 2020 (Navy Seaman Luke Cunningham, Naval Medical Center San Diego).

"As a multi-disciplinary process, it's really due to the dedicated professionals going above and beyond, tracking these patients, and ensuring that they meet their follow-up (appointment) every time," said Peterson. "Military hospitals are really in close proximity. Most of the time, the inpatient and outpatient locations are on the same base.

That, she added, leads to a continuity of care that makes it more seamless to determine if there is any cause to follow up. "In addition, we have social workers and discharge planners who stay on top of the appointments, and our follow-up clinics are in close contact with the NICU (neonatal intensive care unit)."

When a patient sees a civilian doctor for outpatient treatment, or when a family moves across the country after just one follow-up visit, for example, continuity of care can be lost. Missing even one appointment for a baby at risk of ROP can lead to a heartbreaking outcome.

About 14,000 of the approximately 3.9 million babies born each year are affected by ROP, Valentin said, and 90 percent of those have a mild form of the condition and get better on their own. But about 1,000 to 1,500 develop severe ROP, and some 400 to 600 of those go legally blind.

The MHS is transitioning to MHS GENESIS, a new, modern electronic health record. As part of the consolidation process, a registry for ROP patients is in process.

"With the Defense Health Agency's Vision Center of Excellence and the vision care service coordinators, we're looking at coordinating care not just within the military system, but of all military beneficiaries and the medical care provided both by military hospitals as well as civilian hospitals," she said. "A registry that would include all of the beneficiaries (and) ID them based on risk. It's in the development stage, but we would use that data to ensure they are meeting the outpatient follow-up requirements."

She explained the registry would track ROP appointments and identify if an appointment is missed to ensure a follow-up appointment.

"Within (DHA), the clinical communities are already doing the programming for the registries," she said. "A couple have already kicked off."

It will be a matter of weeks before initial programming is done for all the registries, she said.

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