About Propera

Introduction

Dr Umar k. Mian, Dr Naseer Mahmood and Dr Moin were acutely aware of ``Third ROP Epidemic`` Gilbert, about to hit Pakistan. (Rapid increase of number of premature babies with ROP and subsequent blindness, due to survival of smaller babies and inadequate ROP evaluation and treatment). In 2013, ROP evaluations were only available in a few tertiary care private hospitals. There was little awareness of the disease, its treatment and consequences Hashmi. PROPERA (coined by Dr Mahmood) was created to fulfil this urgent need to protect the premature children of Pakistan from blindness

About RoP

The Problem

  • Disease of premature babies
  • No Symptoms, identified ONLY by specific eye exam
  • Need for urgent treatment within 48-72 hours when critical threshold is reached
  • Untreated infants have a very high rate of Life long blindness
  • Coordination between multiple specialists

Spread of RoP

  • In the early 1990s, it became apparent that an epidemic of blindness due to ROP was occurring in middle-income countries. Globally at least 50,000 children are blind from retinopathy of prematurity (ROP) which is now a significant cause of blindness in many middle income countries in Latin American and Eastern Europe and emerging as a new cause of blindness in urban centers in India, China, and other countries in Asia. (Gilbert C. Early Hum Dev 2008)
    Retinopathy of prematurity (ROP) is responsible for blindness in an estimated 50,000 children in the world each year. In middle income countries 15 – 35% of childhood blindness is due to ROP. In the USA between 1999 – 2012, 13 – 14% of childhood blindness was attributed to ROP3 . Studies have shown that this can amount to a financial burden of $69-117 million a year. These estimates do not include loss of potential life long earnings, especially in the developing countries where services to train individuals with blindness are lacking.

Ist Epidemic of RoP

  • In developed countries, the 1940s-1950s saw the first epidemic of ROP due to inadequately monitored oxygen therapy . With changes in clinical practice, and controlled oxygen administration, this epidemic was brought under control.

2nd Epidemic of RoP

  • Increased survival rates of extremely premature (gestational age < 29 weeks) and very low birth weight infants (750- 999g) gave rise to the second epidemic of ROP in the late 1970s and 1980s.

3rd Epidemic of RoP

  • Middle income countries in Latin America, Eastern Europe, India, China and other countries in Asia, with IMR of 9 – 60 per 1000 live births, represent the population at the highest risk of ROP blindness since 1990s.

Pathogenesis and Progression - Phase 1 and 2 of ROP

  • Normal VEGF => Early birth => Decreased VEGF => Normal vessel growth STOPS => Retinal ischemia => Abnormal increase in VEGF => Formation of Abnormal Blood vessels

RoP Examination

Ophthalmologic findings => Stages => Findings

  • Distinct Line Between the Vascularised and Avascularised Region of the Retina
  • The Line noted in stage1 gains both depth and Height
  • Vessels Extend beyond the retina into the Vitreous
  • Partial Retinal Detachment
  • Complete Retinal Detachment

( Ref. Newborn Infant Nurs Rev. @2003 W.B. Saunders)

ICROP classification