Abstract
Preterm neonates are cared for in an environment which is continuously and brightly lit, and is very different to that experienced at any other time of life. The amount of light reaching the neonatal eye is governed by two groups of factors. Physical factors include intensity, spectral characteristics and duration of light exposure. Physiological factors are: Frequency of eyelid opening, transmission of light through the closed eyelid, pupil reactivity and area, transmission by the ocular tissues and retinal surface area. Retinal irradiance declines with increasing postmenstrual age. Mechanisms by which light may affect the neonatal eye and clinical conditions in which light have been implicated are considered.
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Weaver DR and Reppert SM : Direct in utero perception of light by the mammalian fetus. Dev Brain Res 1989, 47: 151–5.
Mutch LMM : Epidemiology, perinatal mortality and morbidity. In Roberton NRC ed. Textbook of Pediatrics, Edinburgh: Churchill Livingsston 1986; 3–19.
Moseley MJ and Fielder AR : Open Letter: Light toxicity and the neonatal eye. Clin Vis Sci 1988, 3: 75–82.
Fielder AR, Foreman N, Moseley MJ, Robinson J : Prematurity and visual development. In Simons K and Guyton DL eds. Infant Vision Research: Basic and Clinical Research. N.Y., Oxford University Press.
Terry TL : Extreme prematurity and fibroblastic overgrowth of persistent vascular sheath behind each crystalline lens I: Preliminary report. Am J Ophthalmol 1942, 25: 203–4.
Locke JC and Reese AB : Retrolental Fibroplasia: The negative role of light, mydriatics and the ophthalmoscopic examination in its etiology. Arch Ophthalmol 1952, 48: 44–7.
Hepner WR, Krause AC, Davis ME : Retrolental fibroplasia and light. Paediatrics 1949, 3: 824–8.
Glass P, Avery GB, Kolinjavadi N, Subramanian S, Keys MP, Sostek AM and Friendly DS : Effect of bright light in the hospital nursery on the incidence of retinopathy of prematurity. N Eng J Med 1985, 313: 401–4.
Ackerman B, Sherwonit E, Williams J : Reduced incidental light exposure: effect on the development of retinopathy of prematurity in low birth weight infants. Pediatrics 1989, 83: 958–62.
Fielder AR, Robinson J, Shaw DE, Ng YK, Moseley MJ : Light and retinopathy of prematurity: does retinal location offer a clue? Pediatrics 1992, 89.
Lawwill T : Three major pathologic processes caused by light in the primate retina: a search for mechanisms. Trans Am Ophthalmol Soc, Rochester: Johnston Press 1982: xxx, 517–79.
Lanum J : The damaging effects of light on the retina. Empirical findings, theoretical and practical implications. Surv Ophthalmol 1978, 22: 221–49.
West SK : Who develops cataracts? Arch Ophthalmol 1991, 109: 196–8.
MacLeod P and Stern L : Natural variations in environment illumination in a newborn nursery. Pediatrics 1972, 50: 131–3.
Robinson J, Moseley MJ, Fielder AR : Illuminance of neonatal units. Arch Dis Child 1990, 65: 679–82.
Hamer RD, Dobson V, Mayer MJ : Absolute thresholds in human infants exposed to continuous illumination. Invest Ophthalmol Vis Sci 1984, 25: 381–8.
Robinson J and Fielder AR : Spectral characteristics of neonatal unit lighting. Invest Ophthalmol Vis Sci (suppl) 1991, 32: 1146.
Landry RJ, Scheidt PC, Hammond RW : Ambient light and phototherapy conditions of eight neonatal care units: A summary report. Pediatrics 1985, 75: 434–6.
Porat R, Brodsky N, Hurt H : Effective eye shielding during phototherapy. Clin Pediatr 1988, 28: 199–200.
Chin KC, Moseley MJ, Bayliss SC : Light transmission of phototherapy eyeshields. Arch Dis Child 1987, 62: 970–1.
Robinson J, Moseley MJ, Fielder AR, Bayliss SC : Light transmission measurements and phototherapy eyepatches. Arch Dis Child 1991, 66: 59–61.
Robinson J, Moseley MJ, Thompson JR, Fielder AR : Eyelid opening in preterm neonates. Arch Dis Child 1989, 64: 943–8.
Friedman E and Kuwabara T : The retinal pigment epithelium IV: The damaging effects of radiant energy. Arch Ophthalmol 1968, 80: 265–79.
Tso MOM, Fine BS, Zimmerman LE : Photic maculopathy produced by the indirect ophthalmoscope. Am J Ophthalmol 1972, 73: 686–90.
Kirkness CM : Do ophthalmic instruments pose a hazard of light-induced damage to the eye? In Chronily-Dillon J, Rosen ES and Marshall J eds. Hazards of Light, Myths and Realities, Eye and Skin. Oxford: Pergamon Press 1986: 179–86.
Moseley MJ, Thompson JR, Levene MI, Fielder AR : Effects of nursery illumination on frequency of eyelid opening and state in preterm neonates. Early Hum Dev 1988, 18: 13–26.
Robinson J, Moseley MJ, Fielder AR : Light and the eye of the preterm neonate. Invest Ophthalmol Vis Sci 1990, 31 Suppl: 119.
Robinson J ( 1990) Light and the eye of the preterm neonate. PhD thesis, Birmingham University, United Kingdom.
Robinson J, Aulcott G, Moseley MJ, Fielder AR : Illumination at the eye of the preterm neonate (in preparation).
Robinson J, Bayliss SC, Fielder AR : Transmission of light across the adult and neonatal eyelid in vivo. Vision Res 1991, 31: 1837–40.
Ludwigh WE and McCarthy EF : Absorption of visible light by the refractive components of the human eye. Arch Ophthalmol 1938, 20: 37–51.
Boettner EA and Wolter JR : Transmission of the ocular media. Invest Ophthalmol 1962, 1: 766–83.
Weale RA : Biography of the Eye. Development, Growth, Age. London: H K Lewis and Co Ltd, 1982.
Said FS and Weale RA : The variation with age of the spectral transmissivity of the living human crystalline lens. Gerontologica 1959, 3: 731–3.
Kishto BM (1968) The photometric evaluation of flashing light sources in relation to their conspicuity. PhD Thesis, University of London.
Vos JJ and Bouman MA : Contribution of the retina to ento-pic scatter. J Opt Soc Am 1964, 54: 95–100.
Dayhaw-Barker P and Barker FM : Photoeffects on the eye. J Toxicol-Cut Ocular Toxicol 1985, 4: 269–99.
Lerman S : Ocular phototoxicity. In Davidson SI and Fraun-felder FT eds. Recent Advances in Ophthalmology. Churchill-Livingstone 1985: 109–36.
Lerman S : Ocular phototoxicity. N Engl J Med 1988, 319: 1475–7.
Barker FM, Brainard GC, Dayhaw-Barker P : Transmittance of the human lens as a function of age. Invest Ophthalmol Vis Sci (Suppl) 1991, 32: 1083.
Kopeiko LG, Yu M, Koretskaya DI, Mitkokh O, Chentsova B : Spectral characteristics of eyeball coats. Vesten Oftalmol 1979, Pt. 1: 46–9.
van den Berg TJTP, de Waard PWT and IJspeert JK : Light transmission through the ocular coats and retinal straylight distribution. Invest Ophthalmol Vis Sci 1990, 31 Suppl: 412.
Robinson J and Fielder A : Pupillary diameter and reaction to light in preterm neonates. Arch Dis Child 1990, 65: 35–8.
Robinson RJ : Assessment of gestational age by neurological examination. Arch Dis Child 1966, 41: 437–47.
Isenberg SJ, Dang Y, Jotterand V : The pupils of term and preterm infants. Am J Ophthalmol 1989, 108: 75–9.
Isenberg SJ, Molarte A, Vazquez M : The fixed and dilated pupils of premature neonates. Am J Ophthalmol 1990, 110: 168–71.
Provis JM, van Driel D, Billson FA, Russell P : Development of the human retina: patterns of cell distribution and redistribution in the ganglion cell layer. J Comp Neurol 1985, 233: 429–51.
Horstein GP and Winkleman JE : Electrical activity of the retina in relation to histological differentiation in infants born prematurely and at full term. Vision Res 1962, 2: 269–76.
Robb RM : Increase in retinal surface area during infancy and childhood. J Pediatr Ophthalmol Strabismus 1982, 19: 16–20.
Packer O, Hendrickson AE, Curcio CA : Developmental redistribution of photoreceptors across the Macaca nem-estrina (Pigtail Macaque) retina. J Comp Neurol 1990, 298: 472–93.
Packer O, Hendrickson AE, Curcio CA : Photoreceptor topography of the retina in the adult pigtail macaque (Macaca nemestrina). J Comp Neurol 1989, 288: 165–83.
Yuodelis C and Hendrickson A : A qualitative and quantitative analysis of the human fovea during development. Vision Res 1986, 26: 847–55.
Banks MS and Bennett PJ : Optical and photoreceptor immaturities limit the spatial and chromatic vision of human neonates. J Opt Soc Am A 1988, 5: 2059–79.
Sykes SM, Robison WG, Waxier M, Kuwabara T : Damage to the monkey retina by broad-spectrum fluorescent light. Invest Ophthalmol Vis Sci 1981, 20: 425–34.
Hansson H-A : A histochemical study of cellular reactions in rat retina transiently damaged by visible light. Exp Eye Res 1971, 12: 270–4.
Riley PA and Slater TF : Pathogenesis of retrolental fibro-plasia. Lancet 1969, ii: 265.
Noel WK, Walker VS, Kang BS and Berman S : Retinal damage by light in rats. Invest Ophthalmol Vis Sci 1966, 5: 450–73.
Wiegand RD, Joel CD, Rapp LM, Nielsen JC, Maude MB, Anderson RE : Polyunsaturated fatty acids and vitamin E in rat rod outer segments during light damage. Invest Ophthalmol Vis Sci 1986, 27: 727–33.
Slater TF, Riley PA : Free-radical damage in retrolental fibroplasia. Lancet 1970, ii: 467.
Howell WL, Rapp LM, Williams TP : Distribution of melanosomes across the retinal pigment epithelium of a hooded rat: implications for light damage. Invest Ophthalmol Vis Sci 1982, 22: 139–44.
Feke GT, Zuckerman R, Green GJ, Weiter JJ : Response of human retinal blood flow to light and dark. Invest Ophthalmol Vis Sci 1983, 24: 136–41.
Riva CE, Grunwald JE, Petrig BL : Reactivity of the human retinal circulation to darkness: a laser Doppler velocimetry study. Invest Ophthalmol Vis Sci 1983, 24: 737–40.
Hill DW and Houseman J : Retinal blood flow in the cat following periods of light and darkness. Exp Eye Res 1985, 41: 219–25.
Stefansson E : Retinal oxygen tension is higher in light than dark. Pediatr Res 1988, 23: 5–8.
Haugh LM, Linsenmeir RA, Goldstick TK : Mathematical models of the spatial distribution of retinal oxygen tension and consumption, including changes upon illumination. Ann Biomed Eng 1990, 18: 19–36.
Dorey CK, Delori FC, Akeo, K : Growth of cultured RPE and endothelial cells is inhibited by blue light but not green or red light. Curr Eye Res 1990, 9: 549–59.
Frederick JM, Rayborn ME, Laties AM, Lam DMK, Hollyfield JG : Dopaminergic neurons in the human retina. J Comp Neurol 1982, 210: 65–79.
Hollyfield JG, Frederick JM, Rayborn ME : Neurotransmit-ter properties of the newborn human retina. Invest Ophthalmol Vis Sci 1983, 24: 893–7.
Berman ER : Biochemistry of the Eye. New York: Plenum Press, 1991.
Katz ML and Robison WG Jr: Autoxidative damage to the retina: Potential role in retinopathy of prematurity. In Flynn JT and Phelps DL eds. Retinopathy of Prematurity: Problem and Challenge. New York: Alan R Liss Inc 1988: 237–48.
Nielsen JC, Naash MI, Anderson RE : The regional distribution of vitamins E and C in mature and premature human retinas. Invest Ophthalmol Vis Sci 1988, 29: 22–6.
Mantagos S, Moustogianni A, Varvarigou A, Frimas C : Effect of light on diurnal variation of blood amino acids in neonates. Biol Neonate 1989, 55: 97–103.
Naash MI, Nielsen JC, Anderson RE : Regional distribution of glutathione peroxidase and glutathione-S-transferase in adult and premature human retinas. Invest Ophthalmol Vis Sci 1988, 29: 149–52.
Johnson AT, Kretzer FL, Hittner HM, Glazebrook PA, Bridges CDB and Lam DMK : Development of the sub-retinal space in the preterm human eye: ultrastructure and immunmocytochemical studies. J Comp Neurol 1985, 233: 497–505.
Chader GJ : Interphotoreceptor retinoid-binding protein (IRBP): A model protein for molecular biological and clinically relevant studies. Invest Ophthalmol Vis Sci 1989, 30: 7–22.
Gonzalez-Fernandez Fand Healy JI: Early expression of the gene for interphotoreceptor retinol-binding protein during photoreceptor differentiation suggests a critical role for the interphotoreceptor matrix in retinal development. J Cell Biol 1990, 111: 2775–84.
Handelman GJ and Dratz EA : The role of antioxidants in the retina and retinal pigment epithelium and the nature of pro-oxidant-induced damage. Adv Free Radicals Biol Med 1986, 2: 1–89.
Sliney DH and Wolbarsht MW : Safety with lasers and other optical sources: A comprehensive handbook. New York: Plenum Press, 1980.
Kitahara K, Tamaki R, Hibino H, Oyama T, eds. Intense Blue Light. In, Verriest G ed colour vision deficiencies VIII Dordrecht, The Netherlands: Martinus Nijhoff/Dr W Junk, 1987. VIII: 21–9.
LaVail MM, Gorrin GM and Repaci MA : Strain differences in sensitivity to light-induced photoreceptor degeneration in albino mice. Curr Eye Res 1987, 6: 825–34.
LaVail MM, Gorrin GM, Repaci MA, Yasummura D eds. Light-induced retinal degeneration in albino mice and rats: Strain and species differences. Degenerative retinal disorders: Clinical and laboratory investigations. Alan R Liss Inc 1987: 439–54.
La Vail MM, Gorrin GM, Repaci MA, Thomas LA, Ginsberg HM : Genetic regulation of light damage to photorecep-tors. Invest Ophthalmol Vis Sci 1987, 28: 1043–8.
O'Steen KW, Anderson KV, Shear CR : Photoreceptor degeneration in albino rats: dependency on age. Invest Ophthalmol Vis Sci 1974, 13: 334–9.
Malik S, Cohen D, Meyer E, Perlman I : Light damage in the developing retina of the albino rat: An electroretinographic study. Invest Ophthalmol Vis Sci 1986, 27: 164–97.
Noell WK and Albnrecht R : Irreversible effect of visible light on the retina: role of Vitamin A. Science 1971, 172: 76–9.
Rapp LM and Williams TP : The role of ocular pigmentation in protecting against light damage. Vision Res 1980, 20: 1127–31.
Penn JS and Thum LA : The rat as an animal model for ret-inopathy of prematurity. Prog Clin Exp Biol 1989, 314: 623–42.
Kremers JJM and van Norren D : Two classes of photochemical damage in the retina. Laser Light Ophthalmol 1988, 2: 41–52.
Abramov I, Hainline L, Lemerise E, Brown AK : Changes in visual functions of children exposed as infants to prolonged illumination. J Am Optom Assoc 1985, 56: 614–9.
Getz L, Dobson V, Luna B : Full-term acuity card norms can be used for preterm children 0-3 years of age. Invest Ophthalmol Vis Sci (Suppl) 1991, 32: 962.
Sebris SL, Dobson V, Hartmann EE : Assessment and pre diction of visual acuity in 3- to 4-year old children bom prior to term. Hum Neurobiol 1984, 3: 87–92.
Fledelius HC : Ophthalmic changes from 10-18 years. A longitudinal study of sequels to low birth weight II visual acuity. Ada Ophthalmol 1981, 59: 64–70.
Fielder AR, Moseley MJ, Ng YK : The immature visual system and premature birth. In Whitelaw A and Cooke RWI, eds. The very immature infant. Br Med Bull 1988, 44: 1093–118.
Ricci B, Lepore D, Iossa M, Santo A, D'Urso M, Mag-giano N : Effect of light on oxygen-induced retinopathy in the rat model. Doc Ophthalmol 1990, 74: 287–301.
Fielder AR, Shaw DE, Robinson J : ROP: Location—a clue to pathogenesis? Invest Ophthalmol Vis Sci 1990, 31 (Suppl): 119.
Dubocovich ML : Role of Melatonin in Retina. In Osborne NN and Chader GJ, eds. Progress in Retinal Research. Oxford: Pergamon Press, 1988: 129–151.
Glass P and Avery GB : Reply to light sleep and development (correspondence). Pediatrics 1987, 796: 1053–4.
Sisson TRC, Glauser SC, Glauser EM, Tasman W, Kuwab-ara T : Retinal changes produced by phototherapy. J Ped-iatr 1970, 77: 221–7.
Rosenfeld W, Sadhjev S, Brunot V, Jhaven R, Zabaleta I, Evans HE : Phototherapy effect on the incidence of patent ductus arteriosus in premature infants: prevention with chest shielding. Pediatrics 1986, 78: 10–4.
Clyman RT and Rudolph AM : Patent Ductus Arteriosus. A new light on an old problem. Pediatr Res 1978, 12: 92–4.
Mann NP, Haddow R, Stokes L, Goodley S, Rutter N : Effect of night and day on preterm infants in a newborn nursery randomised trial. Br Med J 1986, 293: 1265–7.
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Robinson, J., Fielder, A. Light and the immature visual system. Eye 6, 166–172 (1992). https://doi.org/10.1038/eye.1992.33
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DOI: https://doi.org/10.1038/eye.1992.33
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