What is the Relationship Between Retinopathy Blindness and Medical Malpractice

Retinopathy of Prematurity, also known as retrolental fibroplasia or Terry syndrome, is an eye disease that is relatively common among premature and low birth weight infants.

Most often it’s mild with no short-term or long-term consequences. However, each year approximately 1,250 severe cases occur, resulting in complete retinal detachment or blindness in approximately 500 infants.

The most serious consequences of this eye disease can be prevented in almost all cases if the condition is diagnosed and treated in a timely and medically appropriate manner.

When blindness or near-blindness does occur, it often is the result of medical malpractice and other substandard health care performed by the hospital, the neonatal ICU, the neonatologist, the pediatrician, and/or the ophthalmologist.

Retinopathy of Prematurity (ROP) is the second highest cause of blindness in children in America. It affects about 15,000 premature babies each year, with several hundred suffering complete or near-complete blindness. One of the most famous people to be blinded by ROP is musician Stevie Wonder.

The illness mainly affects infants born prior to 32 weeks gestation and weighing less than three pounds. The smaller the baby at birth the more likely ROP will occur. Retinopathy of Prematurity generally occurs in both eyes at the same time because the blood vessels in a premature baby’s eyes fail to grow normally as a result of a lack of oxygen and nutrients.

Other factors that are associated with ROP include oxygen toxicity, oxygen deficiency (hypoxia), anemia (lack of red blood cells), poor weight gain, blood transfusion, infections, sepsis, respiratory distress, carbon dioxide toxicity (hypercapnia), slow heart rate (bradycardia), and breathing difficulties.

ROP falls within a range of severity, from no symptoms to total blindness. The type and severity of ROP depends on the location of the disease within the eye, and the appearance of the retinal vessels.

If premature infants are not carefully monitored for the development of ROP, the blood vessels in the baby’s eyes can begin leaking blood. This can result in scarring, which then can result in a partial or complete retinal detachment, and blindness.

Babies who suffer from ROP are at a greater risk to eventually develop other eye diseases, including retinal detachment, myopia (nearsightedness), strabismus (crossed eyes), amblyopia (lazy eye), and glaucoma.

The most significant risk factor for ROP is prematurity. Thus, doctors must follow proper and available medical care to help prevent, or at least delay for as long as possible, premature births.

Health care providers (and specifically neonatologists, pediatricians and ophthalmologists) should screen all babies for possible ROP if they are born sooner than 32 weeks, or weigh less than 3 pounds at birth. This screening should be started within one week of birth, and continue until it’s clear the baby is not suffering from ROP.

The screenings should occur at specific intervals in order to determine whether the infant’s blood vessels are developing normally. Doctors should be carefully looking for the growth pattern of the blood vessels, making sure they are along the surface of the retina, and not toward the center of the eye.

They should also be looking to make sure the blood vessels have not become enlarged and twisted (“Plus Disease”). Finally, they need to make sure the retina is not becoming detached. Retinal detachment is the main cause of visual impairment and blindness with ROP.

When symptoms of ROP are suspected, health care providers should consider the following treatments, which generally should begin within forty-eight hours of diagnosis:

1. Oxygen treatment;
2. Freezing to prevent abnormal blood vessels from spreading (cryotherapy);
3. Retinal ablation laser therapy to prevent abnormal blood vessels from spreading (photocoagulation);
4. Placement of a silicone band around the eye and tightening it (scleral buckle);
5. Removing the vitreous and replacing it with a saline solution (vitrectomy); and
6. Retina repair surgery.

If treated timely and properly, the infant will not likely sustain any permanent, serious loss of vision as a result of ROP. However, even if the physicians see no permanent damage caused by ROP, they should instruct the parents to seek a follow-up consult within eight to twelve months to monitor for other diseases that might arise in the future as a result of the infant experiencing ROP.

On of the most common issues found in retinopathy malpractice occurs when the mother and child are released from the hospital, and the family is not provided a proper transfer to a specialist and/or the treating hospital physicians fail to follow-up on the care being provided in a timely manner.

Retinopathy of Prematurity

It should be the responsibility of the neonatologist to identify all eligible infants in the nursery and set the appropriate timing for the initial ROP exam. Each week, the neonatologist should make a list of all eligible infants who require a fundus examination. An order for this examination should be placed in the baby’s medical record and the ophthalmologic consultant should be notified. Additionally, the patient’s family should be informed of the nature and possibility of ROP. To read more, click American Association for Pediatric Ophthalmology and Strabismus

Retinopathy of Prematurity Requires Diligent Follow-up Care

There are approximately 3.9 million infants born in the U.S. each year. About 14,000 are affected by ROP and 90% of those affected have only mild disease. About 1,100- 1,500 develop disease severe enough to require medical treatment and 400-600 infants each year in the U.S. become legally blind from ROP. To read more, click Ophthalmic Mutual Insurance Company

An Ophthalmology Crisis: Retinopathy of Prematurity

The preterm birth phenomenon, coupled with fewer specialists who are willing to screen infants for ROP, will eventually result in higher rates of childhood blindness due to lack of early detection. To read more, click Retinal Physician

We will be seeking the following damages for you and your child:

1. Past and future medical expenses.
2. Past and future mental pain and suffering.
3. Past and future wage loss.
4. Other economic losses you and your child might sustain as a result of your child’s injuries, such as home health care, daycare, special education requirements.
5. Punitive damages, if appropriate.

Malpractice and The Quality of Care in Retinopathy of Prematurity

A review of thirteen ROP malpractice cases was conducted. These infants must be screened and followed. The participating ophthalmologist must have the requisite knowledge and skill and be responsible for appropriate retinal diagnosis and management. To read more, click Transactions of the American Ophthalmological Society

Retinopathy of Prematurity Malpractice Claims

Many preventable factors can be addressed to improve ROP care. It is essential to ensure that ophthalmologists, neonatologists, pediatricians, and families are updated on current guidelines for ROP screening and treatment and to facilitate follow-up appointments before patient discharge from the hospital. To read more, click Journal of the American Medical Association

Facts About Retinopathy of Prematurity

The most effective proven treatments for ROP are laser therapy or cryotherapy. Laser therapy “burns away” the periphery of the retina, which has no normal blood vessels. With cryotherapy, physicians use an instrument that generates freezing temperatures to briefly touch spots on the surface of the eye that overlie the periphery of the retina. To read more, click National Eye Institute