Kathleen M. Stoessel, MD: Preserving eyesight in the most vulnerable patients

[September 2008] Ophthalmologist Kathleen M. Stoessel, MD, is often pitted in a race against the clock when treating her youngest patients. Stoessel heads the Retinopathy of Prematurity (ROP) program, monitoring and treating premature infants who risk impaired vision or even blindness if she doesn’t act quickly.

Retinal vessels normally develop between the 16th and 38th weeks of gestation, but that growth can be disrupted in babies born prematurely. As a result, these infants are prone to ROP—abnormal cellular proliferation where the vessels have stopped growing. ROP will often resolve on its own, but if it progresses, the resulting neovascularization and scar tissue can lead to a detached retina. “If that happens, there’s a limited chance for any really good vision in these premature babies, even after retinal detachment surgery,” said Stoessel.

Stoessel checks premature infants for the earliest signs of ROP and monitors their progress. “ROP is never static,” she said. “It’s always changing until they get to the point where it resolves one way or another, either by laser treatment or by nature.” An ongoing clinical trial sponsored by the National Eye Institute has determined specific “threshold” criteria at which the risk of retinal detachment is greater than 50 percent and laser treatment is recommended. For best results laser treatment must be done within 48 hours of the infant developing those threshold criteria, which relate to the degree of abnormal cell growth and how far from the retina it occurs. Treatment involves a laser that makes a 360-degree circuit, focusing on an area adjacent to the abnormal vessel junction. Each year Stoessel and her colleagues perform the treatment on about 48 babies at Yale.

Stoessel also evaluates children under two years of age for retinal hemorrhages in cases where there might be a history of abuse. “Certain clinical appearances of retinal hemorrhages are consistent with shaking, even though there may be no other external injuries to the baby,” she said. While many of her patients are children, she also treats adults for conditions such as diabetic retinopathy and macular degeneration.

Although she originally planned to pursue internal medicine, Stoessel realized during her internship the importance of visual function. “My patients taught me that they can deal with other problems if they have visual function,” she said, “but if that goes too, they can’t do something as simple as read a book or look out a window.”

- Originally published in the August/September 2008 issue of Yale Practice.