"Baby-blinding retinopathy of prematurity and intensive care nursery lighting"
A detailed documentation of an ongoing medical malpractice and its continued cover- up that severely harms many premature babies 
by H. Peter Aleff

The full text of this technical article is posted on the "baby-blinding lights" pages in this section; it was published in the clinical journal

• Iatrogenics  (The Official Journal of the International Society for the Prevention of Iatrogenic Complications--ISPIC) Volume 1, Issue 2, dated April-June 1991: 2: 68-85 but  distributed in Summer 1992.

Table of contents with summaries
1.1. Abstract
Each year, thousands of premature babies in intensive care nurseries lose their sight to ROP. This blinding began with the introduction of fluorescent lamps.

Industrial safety researchers have determined the wavelengths where the retina is most vulnerable to blue-light damage. The most intense energy spike in the spectrum of the fluorescent lamp shines precisely into that vulnerability window.

Typical nursery lighting exposes the preemie in 15 minutes or less to the US industrial safety regulations' danger-limit dose of retinal irradiation for adults.

Preemies have none of the adults' protections against damaging light.

Light hitting a preemie's still migrating retinal cells can garble the cells' migrating instructions and make them stick to other cells. Under the electron microscope, retinae damaged by light and by ROP show the same abnormal adhesions between cells.

The danger from light to immature eyes has been regularly documented for the past two decades. Some researchers say light is safe for preemies because of reported ROP damage even to eyes shielded with patches, but all these had the patches applied after the damage had been done.

Bright nursery lighting brings no benefit to babies but does them much harm.

1.2. Incidence of the retinal damage
ROP now affects in the US alone several thousand babies each year who wind up with severe visual impairments or become totally blind. It accounts for more cases of blindness among children than all other causes combined, but no statistics exist about its incidence.

In a half century of this epidemic, the pediatricians in charge have so far entirely neglected the most effective tool against epidemics which is the collecting of epidemiological data.

1.3. Description of the disease
ROP is a disturbance in the formation of the developing retinal bloodvessels that suddenly become tortuous and can lead to the detachment of the retina.

1.4. Current therapies
Cryotherapy destroys some of the remaining retina in the hope to prevent the rest from detaching further. The outcome of this scorched-earth invasion is uncertain, often poor.

1.5. ROP and the introduction of fluorescent light
The first babies to develop ROP were born in 1940. ROP had never been observed before and could not be traced in retrospective studies of older blind people. Its sudden appearance coincided with the appearance of fluorescent lamps which had been introduced commercially at the New York World Fair in 1938/39.

Both the lamps and the disease spread quickly from coast to coast, and ROP soon became the major cause of blindness among children in the US. Like the lamps, ROP long remained unknown anywhere else until 1948/49, when fluorescent lamps became available in post-war Europe and other industrial countries; then, ROP suddenly affected preemies in these countries, too.

It followed again the same pattern of an exploding epidemic that started almost simultaneously in the most modern and best-equipped neonatal nurseries and soon became as common there as in their US counterparts and role models.

1.6. Retinal vulnerability to fluorescent light
The retina's defenses against the so-called blue-light hazard are weakest from 435 to 440 nanometers of light wavelength which is between blue and violet; fluorescent lamps emit their most intense energy spike at a wavelength of 435.8 nanometers.

1.7. Damage-weighted retinal irradiance
The article gives the calculations of the cumulative photochemical retina damage, and these are easily verified.

For an update with a slightly smaller pupil diameter subsequently reported in the literature, see pages 86 and 87 where I give the blue-light hazard for that eye geometry, as well as the aphake hazard to that eye when transparent like that of a preemie. In all cases, the preemies' exposure works out to many times more than the adult danger threshold value.

1.8. Light levels in some intensive care nurseries
Most nursery staff are entirely unaware of the blue-light hazard, and many raise the light level even above the overbright one recommended by the Academy of Pediatrics. Some also carelessly expose preemies without eye patches to their neighbors' bilirubin lamps or even to direct sunlight that shines through their almost transparent eyelids and sears their retinae.

1.9. A preemie's retinal vulnerability
Wombs have no fluorescent lamps, and preemies meant to have stayed in their protected darkness are much more vulnerable to harsh light than adult workers.

The progressive yellowing of the human lens with age provides some protection to adolescents and adults but not to babies. Babies are still aphake, that is their lens does not block the incoming light even deep in the still more damaging wavelengths below 435 nm where fluorescent lamps emit several additional concentrated energy spikes.

Furthermore, the clinical literature documents abundantly that cells still in their development stages are many times more susceptible to damage from radiation than cells already grown into stable structures, and that preemies lack a number of other adult protections.

1.10. Electron microscope studies
of damage from light and from ROP
Both reveal the same abnormal adhesions between adjacent cells. In preemie eyes, these adhesions are bound to interfere with the formation of the retinal bloodvessels these cells are programmed to become.

1.11. Some studies of ROP and light
Most of the studies about ROP and light demonstrate their authors', peer reviewers', and editors' disregard for basic logic.

All the trials that found no ROP difference between babies exposed to light and those allegedly protected applied the protection from light only after the babies had already been grossly over-exposed. Some of the authors delayed the protection despite their own admission that "the most crucial time [for the protection] may be immediately after birth".

1.12. Bright nursery lighting offers no benefit for babies
Those who claim the bright lighting is needed allege contrived reasons that have long been debunked but that continue to guide intensive care nursery practices and to harm preemies.

1.13. Conclusions and recommendations
Protect preemies from even short exposures to bright light, including stray light from sun and phototherapy lamps, filter out all wavelengths below 500 nanometers, and stop the unjustified oxygen withholding.

NOTE: After this article went to press, I learned of two sources that offer plastic shields or sleeves which filter out the offending wavelengths below about 500 nanometers from fluorescent lamp fixtures and tubes. These are

Illumination Technology, Inc., 2100 St. Heather Lane, Gambrills, MD 21054, phone 800-631-1170; product name "Litho Gold Shield" and

Gentex Corporation, P.O. Box 315, Carbondale, PA 18407, phone 717-282-8631, fax 717-282-8555. Contact Lisa Walkush, Filtron Product Manager.

Continue to the full article and its documentation.