From the Newsweek issue of August 28, 1989,
Society Section, "Medicine", page 52:
Trouble in the Nursery
Are hospital lights blinding premature babies?
by Geoffrey Cowley with Pat Wingert in Washington
When David Aleff entered the world on a November morning in 1984, no one quite expected him to make it through the day. Even if the two-pound creature somehow survived, the doctors predicted, being born at just 24 weeks would surely leave him retarded.
Three months later the baby went home alive, alert and apparently thriving. But when Meg and Peter Aleff took him in for an ophthalmological exam, they learned there was a problem. The blood vessels in his eyes had proliferated wildly during his first months of life, detaching his retinas from the surrounding tissue. He was totally blind.
It's common knowledge that kitten-size preemies are surviving as never before. What's less well known is that many are going home blind, victims of a condition called retinopathy of prematurity.
ROP was rampant during the 1940s and early '50s. The affliction subsided in the late '50s, after physicians realized they'd been pumping too much oxygen into incubators -- but the number of victims has since risen markedly.
More than 2,000 American babies are now severely handicapped by the disease every year, and at least 500 go blind. Only congenital defects take a greater toll on children's eyes.
The new epidemic is largely a testament to medical progress: if babies weren't surviving at such low birth weights (and with such immature retinas), they wouldn't be losing their sight. Yet there are nagging suspicions that hospitals are making things worse.
Is it possible, as some experts now fear, that intensive-care nurseries are repeating the mistake they made with oxygen -- that they're injuring children with overdoses of light?
It's not inconceivable. Physicians have known for some time that light waves can damage the retina. That's why they bandage infants' eyes before placing them under the powerful lamps used to treat jaundice. Fluorescent ceiling lights (which produce far less radiation) have been presumed safe. But the lights in intensive-care nurseries are now five to 10 times as bright as they were 30 years ago. And many preemies are exposed to them 24 hours a day, so that nurses can monitor subtle changes in their skin color.
"No one has proved that chronic exposure [to modern nursery lights] will damage a baby's retina," says David Sliney, a medical physicist with the U.S. Army Environmental Hygiene Agency. "But it's a believable theory."
The strongest evidence linking light to ROP comes from a 1985 study headed by Penny Glass, a developmental psychologist at the George Washington University Medical School. Glass and her colleagues compared ROP rates for two groups of premature babies: an "unprotected" group that received standard nursery care and a "protected" group whose incubators were shaded by sunglass-type filters.
The study, published in the New England Journal of Medicine, turned up a "significant relation between the intensity of light exposure and the incidence of retinopathy of prematurity." Indeed, the unprotected preemies suffered 20 percent more ROP than those in the shaded incubators.
Unfortunately, Glass's experiment was confined to a couple of Washington, D.CĄ hospitals. And because the two patient groups were treated sequentially rather than simultaneously, it's possible that factors other than light reduction caused the decline in ROP.
No one has performed the more rigorous study needed to confirm Glass's findings, but two Dallas-based ophthalmologists are now laying the plans for one. In a prospectus recently submitted to the National Eye Institute, Drs. Rand Spencer and George Sanborn propose having 23 clinics assign preemies randomly to three treatment groups. Some kids would wear eye patches or shaded goggles around the clock, some would wear them only at night and some would go unprotected.
By tracking the three groups simultaneously, and plotting ROP rates against actual exposure, the researchers would be able to rule with some confidence on the presence of a hazard.
Policy paradox: The question is whether the lights should blaze until the evidence is in. Some hospital nurseries have taken steps to reduce unnecessary exposure, but physicians generally agree that it would be foolish to change clinical standards without conclusive findings.
"If you simply reduce the light without doing it systematically" says Dr. William Silverman, a prominent neonatologist who spent several decades studying ROP, "you don't end up knowing whether there was ever a problem, or whether you've addressed it adequately."
When oxygen was first implicated in ROP, he recalls, many health departments restricted the concentrations preemies received -- even though the problem had less to do with the richness of the stuff than with the amount of time babies spent breathing it. Cutting the concentration helped reduce ROP rates, but it left many kids brain-damaged or dead.
Peter Aleff doesn't buy Silverman's brand of caution. While the medical community waits for perfect proof of a hazard, says the anguished father, babies are being subjected to "a merciless torture we would no longer inflict on our worst enemies."
"The epidemic of blinding could easily have been ended long before David and thousands of other now blind children were born," Aleff charged in a recent New York Times op-ed piece, "if doctors had applied the medical research described in their own journals."
Unfortunately, eliminating ROP will never be as simple as turning down the nursery lights, for light is at most a small part of the problem. "The primary cause of ROP is prematurity," Penny Glass admonishes. "To prevent it, you would have to prevent prematurity."
True, but if further study confirms that eye shades can reduce the incidence by 20 percent, a lot of parents are going to wonder why their children didn't get them.
by Geoffrey Cowley with Pat Wingert in Washington
Responses to this article sent to Newsweek but not published:
1) from Charles B. Inlander, President,
People's Medical Society,
462 Walnut Street, Allentown, PA 18102
August 23, 1989
Your article "Trouble in the Nursery" (Newsweek: August 28, 1989) illustrates the arrogance and self-serving nature of many contemporary medical practitioners.
The evidence is quite obvious that fluorescent lighting is contributing greatly to premature infants being blinded in hospital nurseries. But, the medical sources you cite want to blind more in order to satisfy their warped medical curiosity.
It is appalling that two ophthalmologists have asked for a grant to conduct a study that will leave one-third of the premature infants in the experiment fully exposed to fluorescent light and possible blindness simply to prove the point. It is even more appalling for a "prominent neonatologist" to suggest that turning off the lights is like depriving a child of oxygen.
Apparently, the notorious Dr. Mengele, before his death, had some visiting professorships in American medical schools.
Sincerely, Charles B. Inlander, President
2) from H. Peter Aleff, August 25, 1989
Re.: Your article "Trouble in the Nursery"
(August 28, 1989)
Thank you for drawing attention to my campaign against the unnecessary blinding of premature babies. You mention that Dr. Spencer and Dr. Sanborn want to launch a multi-hospital study with three groups of babies exposed to different degrees of hazard from excess light. They will have to violate the laws about informed consent and lie to the parents about the well-documented eye damage light can cause.
Or do they expect sane parents to knowingly have their baby risk going blind in such an inhuman trial, just so that some medics can publish a paper about how many babies they blinded by which method?
No one can honestly claim that the bright lights provide any benefit whatsoever to babies who still belong in a dark womb. Dr. Silverman thinks medical research is more important than protecting patients from a known danger: "If you simply reduce the light without doing it systematically, you don't end up knowing whether there was ever a problem."
So what, Dr. Silverman, if you simply reduced the light and the blinding ended? Tens of thousands of already blind people could tell you that there was indeed a problem, and there is no need to add to their number just to confirm this.
You quote Dr. Glass echoing the medical mantra that the primary cause for retinopathy of prematurity is prematurity. This is like saying that the primary cause for airplane crashes is gravity -- true in both cases, but too meager to explain anything.
How many doctors will it take to change the lightbulbs in the intensive care nurseries? So far, those in charge have been too conceited to admit the current bulbs are bad.
Sincerely, H. Peter Aleff