Transcript of the Canadian Broadcast Corporation's Market Place TV program
Babies and Blindness
produced by Nancy Hawkins and broadcast on March 6, 1990, with Norma Kent and Bill Paul as narrators:
Narrator: It's called retinopathy, a disorder that prevents the proper development of the eye. In some cases, it leads to permanent damage, even total blindness. Researchers are finding there is an increase of this condition among babies born prematurely and they have been trying to find out why. back on its use.
One culprit, some say, is the bright level of fluorescent lights in hospital nurseries. Lights that are simply to harsh for the delicate eyes of a premature baby.
Like most five year olds, David Aleff likes nothing better than to play. But young David got his start in life because he could fight. David was born three months premature, weighing less than a kilogram. Doctors told his parents David would probably die within a day or two.
Peter Aleff: An hour after his birth, I was admitted to the nursery and I saw him there lying in his bassinet, a very small little bundle all bruised and brown and purple. I stroked his back with just this one finger and he arched his back as a cat would do when you stroke him. And then I knew that this guy would make it.
Narrator: David spent the first three months of his life in an hospital intensive care nursery. Shortly after he was released, doctors told the Aleffs that the disease known as Retinopathy of Prematurity had left David completely blind.
Aleff: It took us a while to actually believe that he would be blind. We sort of hoped either for a miracle or that it just would turn out not to be true. But that stage passed quickly.
Narrator: David was one of hundreds of preemies who are blinded each year when their retinas fail to develop properly. Thousands more experience a lesser degree of visual impairment. There are many theories about what causes retinopathy in premature infants, but no real proof.
So, Peter Aleff, an engineer in Vineland, New Jersey, took two years off work to research the causes of his son's disease. He became convinced from reading the medical literature that his son's blindness was caused by the high level of fluorescent lighting in hospital nurseries.
Aleff: If neonatologists heeded their own clinical literature, then not only David but tens of thousands of other people would have their eyesight.
Narrator: The theory that light could play a role in retinopathy is controversial, but it is not new. Doctors have been trying for years to discover what causes this disease. Back in the 40's and 50's there was an epidemic of retinopathy. Excessive use of oxygen was identified as the likely cause and the epidemic was brought under control when doctors cut
But now, three decades later, there is a disturbing increase in the incidence of this disease. And that has motivated researchers to consider other variables, including the possibility that artificial light could play a role.
Penny Glass is a developmental psychologist at the George Washington University Medical School in Washington, D.C. In 1965 she conducted a study which examined the relationship between the bright fluorescent lights used in most hospital nurseries and the incidence of retinopathy. Dr. Glass's study, published in the New England Journal of Medicine, found that preemies exposed to the lights were as much as 32% more likely to develop retinopathy than those babies who were protected from the light.
Although Glass is the first scientist to find a possible relationship between light and retinopathy in babies, her findings are backed up by earlier research done on animals which show that artificial light can damage their eyesight.
Dr. Glass admits her findings are not conclusive, but she points out that there have never been any studies done to prove fluorescent lights are safe.
Dr. Glass: My personal feeling is that what we are dealing with here is the lack of safety standards and that there are no known safety standards to support what is currently being used in a nursery. And we do believe that the most conservative approach is to actually shade the baby's eyes until more evidence is in that brighter lights are actually safe.
Narrator: And the lights are bright. In fact they are now five to ten times brighter than those used in nurseries thirty years ago. Light levels in most nurseries tend to average around 90 foot candles. That is twice as bright as standard office lighting and babies are exposed to these lights 24 hours a day for as long as three or four months.
But this is one intensive care nursery where they have turned the lights down: the National Children's Medical Center in Washington, D.C., one of the oldest and most respected children's hospitals in North America.
Following the publication of Dr. Glass' study, the hospital installed new lighting in their intensive care nursery. The overhead lights are controlled by individual dimmer switches. When the baby is not being examined, the lights are turned off.
Dr. Glass: Adequate light levels are appropriate to examine a baby. But I think it can really do harm to a baby's developing visual system. Not just in terms of retinopathy of prematurity, but it is extremely stressful for anybody to be under bright lights such as that continuously.
We find that when you go into a nursery and the lights are low then people typically lower their voices as though somebody might be sleeping, as though they are going into a nursery.
Narrator: The National Eye Institute in the United States is considering funding a major study on the relationship between fluorescent lights and retinopathy. But it could be years before any results are available. So the question is, do we turn the lights down now or do we wait until the evidence is in and possibly risk damaging the eyes of premature babies?
Dr. Andrew McCormick: I really find it astonishing that physicians would think that light might be damaging to the interior of babies' eyes, particularly when the eyes are closed virtually all of the time.
Narrator: Dr. Andrew McCormick is a pediatric ophthalmologist at VC Childrens Hospital In Vancouver and is considered to be a leading authority on retinopathy in Canada.
Dr. McCormick: You may think that I am being facetious but I am not, when I suggest to you that light levels have as much relationship to the development of serious retinopathy of prematurity as a similar study that might be done that relates the damage to the height of the nurses doing the work in looking after the baby.
Dr. Glass: I guess I'll have to respond to that. I think the animal evidence suggests that light exposure may really disrupt retinal metabolism for one thing: that extreme light exposure in an animal can damage the retina. And with those two possibilities even, it really can disrupt the developing visual system of the preemie and potentially contribute to retinopathy of prematurity.
The primary cause of retinopathy of prematurity really is immaturity of the retina. Oxygen is suggested as one factor and our studies suggested that light may be an additional factor.
Narrator: But Dr. McCormick is not convinced.
Dr. McCormick: (Shown shining a bright light into the eyes of a baby clearly uncomfortable with this procedure) I in fact use an exceedingly bright light in examining the interior of the babies' eyes.
I don't know what the light level is in terms of foot candles, but I can tell you that the babies are well aware of the fact that they are having their eyes examined. It has never been suggested that this is damaging to the baby's sight and there have been millions and millions of man hours of exposure to fluorescent lights and nobody's come up and demonstrated that they are damaging.
Narrator: There are no federal regulations for light levels in hospital nurseries. However, for the general well being of infants, Health and Welfare Canada recommends a lighting level of just 30 foot candles with brighter lights used for examinations only. These levels are intended as guidelines only.
Nonetheless, we found that none of the hospitals we contacted had light levels that low. In fact most hospitals were unaware the guidelines existed.
St. Joseph's Hospital in London, Ontario was one of the exceptions. The overhead lights here are not as bright as in some nurseries and following the release of Glass' study the hospital staff decided to go one step further. They now put cloths over the top of the isolettes to cut down on the amount of light to which babies are exposed.
Dr. Graham Chance is a neonatologist and the Director of Nurseries at St. Joseph's. He says that Dr. Glass' study is an important one but more research is needed before hospitals commit themselves to installing new lighting In their nurseries.
Dr. Chance: Perhaps lighting is one of the factors of the cause. We don't really know, do we. To change the lights in this area would cost us $17,000 to put in dimmer switches which isn't a huge sum. By comparison of a baby's eyes it's no sum, nothing.
But, as I say, we have to have better evidence to go beyond where we've gone. Where we've gone is some protection.
Narrator: Peter Aleff gets impatient when he hears doctors talk about hospital budgets and the need for more research. He wants the lights lowered now.
Aleff: They are damaging the babies while they are searching for proof. They do not accept evidence which is already in their literature and has been there for more than 20 years. What sort of proof do they want?
Narrator: Aleff now spends most of his spare time trying to convince the medical community, politicians, and the general public of the need to turn down the nursery lights. And, if nothing else, he has generated media attention. There was one article In "The New York Times" another in "Newsweek". And Aleff has made the circuit of talk shows like "Good Morning America". His message Is simple.
Aleff: Whenever there is no need for bright lighting to do an examination, then turn them down with a dimmer switch.
Narrator: But his one man crusade has so far not produced the results he had hoped for. It must be tough to fight against doctors who have been trained all their lives. How long will you keep this up?
Aleff: Until the nursery lights are turned down. I will not stop this campaign because I feel if I stop I would be like someone who has a life preserver and does not toss it to someone who is drowning right here in the river.
Narrator: Have you had much encouragement?
Aleff: I don't need encouragement. I know what I have to do.
Narrator: Well, it sounds like you're David and Goliath is on the other side of the fence there.
Aleff: Yeah, but remember, David won!
Norma Kent: It must be very frustrating for Peter Aleff to do all this work and see so few results.
Narrator: Well, he seems to be undaunted and spends all his spare time working at this. He has pushed, for instance, the New York State Department of Health to do a study on retinopathy. We got the results of that study yesterday. And while the Department still says the jury is out on what causes the disease, they are recommending hospitals in the meantime to turn the lights down as far as possible in the nurseries.
So, while Peter Aleff may not have the total impact he is looking for, there is no doubt he is getting results.