Effects of Light Reduction on Retinopathy of Prematurity (Light-ROP), The

Purpose

To evaluate the effect of ambient light reduction on the incidence of retinopathy of prematurity (ROP).

Background

Despite progress during the past decade in treatment of ROP, this disease still poses a significant (approximately 2.1 percent) risk of blindness to extremely low birth-weight (<1,251 grams) preterm infants. current estimates indicate that about 27,000 infants of extremely low birth weight are born annually, of which 74 percent will survive. as techniques of managing smaller and less mature preterm infants continue to improve, it is expected that the number of infants at risk for blindness will continue to increase.

For infants weighing less than 1,251 grams at birth, the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Study has shown that the risk of developing severe, acute (threshold) ROP is 6 percent. Although cryotherapy, when applied at the time of threshold ROP, reduces the rate of unfavorable visual outcome, 35 percent of eyes that develop this level of severe, acute disease are blind 1 year after treatment. Moreover, cryotherapy is destructive. Even when cryotherapy prevents progression to retinal detachment, it is associated with peripheral retinal destruction and may, in some cases, be associated with subnormal central vision due to high myopia and/or macular scarring. Corrective surgical treatments for retinal detachment caused by ROP have proven to be of little visual benefit. A preventive treatment for ROP that is safe, efficacious, easily applied, and inexpensive is desirable.

The investigators hypothesize that reducing the amount of light that reaches the eyes of preterm infants may be effective in preventing ROP. Although previous reports on the use of light reduction to the eyes of preterm infants in the nursery have produced conflicting results, there are sufficient reasons to believe that this strategy may be effective in reducing the incidence and severity of ROP. These reasons center on the role of light in the production of destructive free radicals. Supplemental oxygen produces the same free radicals, and the two mechanisms may be additive.

Description

In this masked, controlled study, infants weighing less than 1,251 grams at birth were prospectively randomized within 24 hours of birth to wear goggles or not to wear goggles. Goggles contain 97 percent near neutral density filters and were worn until the infant reached either 31 weeks gestational age or 4 weeks postnatal age, whichever was longer. The goggled and nongoggled infants were exposed to the same ambient light conditions within any given Study Center. Eyes of all infants were examined on a prescribed schedule by certified examiners to determine the incidence of any confirmed ROP.

The primary objective of this study is to answer the following question: Does light reduction to the eyes of extremely low birth-weight infants decrease the incidence of any confirmed ROP (at least 3 contiguous clock hours, any stage, any zone)? The primary end points are therefore ROP or full vascularization.

The secondary objective of this study is to evaluate the following question: Does light reduction to the eyes of extremely low birth-weight infants decrease the incidence of more severe ROP (prethreshold ROP -- the secondary end point)?

The study has recruited approximately 400 infants, equally divided into goggle-wearing and control group. Since randomization must occur within 24 hours of birth, the investigators anticipate a mortality rate of between 10 percent and 20 percent of enrollees prior to outcome. The study is in the followup phase with regular ophthalmologic exams until either ROP regression or normal full retinal vascularization is established. A final exam occurs at adjusted age 6 months.

Patient Eligibility

Premature infants weighing less than 1,251 grams at birth and having a gestational age of less than 31 weeks were eligible for randomization. Consent must have been obtained within 24 hours of birth. Patients with major congenital anomalies are excluded.

Patient Recruitment Status

Enrollment began in July 1995 and ended in March 1997.

Current Status of Study

Complete.

Results

There were 188 infants in the group that wore goggles and 173 in the control group who survived and were available for followup. The mean birth weights were 906 grams (1.99 pounds) in the goggles group and 914 grams (2.01 pounds) in the control group. The mean gestational ages were 27.4 weeks and 27.2 weeks, respectively. The mean ambient-light level adjacent to the infants' faces was 399 lux (lumens per square meter) for the goggles group and 447 lux for the control group. ROP was diagnosed in 102 infants (54 percent) in the goggles group and 100 (58 percent) in the control group (relative risk, 0.9; 95 percent confidence interval, 0.8 to 1.1; P=0.50).

A reduction in the ambient-light exposure does not alter the incidence of ROP.

Publications

Kennedy KA, Fielder AR, Hardy RJ, Tung B, Gordon DC, Reynolds JD, for the LIGHT-ROP Cooperative Group: Reduced Lighting Does Not Improve Medical Outcomes in Very-Low-Birth-Weight Infants. J Pediatrics 139: 527-31, 2001.

LIGHT-ROP Cooperative Group: The Design of the Multicenter Study of Light Reduction in Retinopathy of Prematurity (LIGHT-ROP). J Pediatr Ophthalmol & Strabismus 36: 257-263, 1999.

Reynolds JD, Hardy RJ, Kennedy KA, Spencer R, van Heuven WAJ, Fielder AR, for the Light Reduction in Retinopathy of Prematurity Cooperative Group: Lack of Efficacy of Light Reduction in Preventing Retinopathy of Prematurity. N Engl J Med 338: 1572-1576, 1998.

Clinical Centers

New York
The Children's Hospital of Buffalo
Buffalo, NY

Texas
The University of Texas
Southwestern Medical Center at Dallas
Dallas, TX

University of Texas
Health Science Center, San Antonio
San Antonio, TX

Resource Centers

Chairman's Office
James D. Reynolds, M.D.
Department of Ophthalmology
The Children's Hospital of Buffalo
219 Bryant Street
Buffalo, NY 14222
Telephone: (716) 878-7975

Coordinating Center
Robert J. Hardy, Ph.D., Professor of Biometry
University of Texas Health Science Center, Houston
School of Public Health Coordinating Center
1200 Herman Pressler, Suite E827
Houston, TX 77030
Telephone: (713) 500-9550

NEI Representative

Donald F. Everett, M.A.
National Eye Institute
National Institutes of Health
Executive Plaza South, Suite 350
6120 Executive Boulevard, MSC 7164
Bethesda, MD 20892-7164
Telephone: (301) 496-5983
Fax: (301) 402-0528

Last Updated: 4/7/2003

This page was last modified in October 2008

U. S. Department of Health and Human Services

National Institutes of Health