Battle in the Dark

Many of the sharpest eye specialists in the U.S. gathered last week at Johns Hopkins' Wilmer Ophthalmological Institute for their yearly exchange of views. The newest and most baffling problem in the field of eye disease was not on their agenda, and for good reason: although some of the eyemen had done a vast amount of work on it in the past year, none felt that he had learned anything definite enough to get up and talk about. And the chances are that if any of them had, few of his colleagues would have accepted his findings.

The mysterious disease is retrolental fibroplasia (RLF), in which there is a fibrous thickening of tissue behind the lens in the eye. Nobody knows the cause. The effect is to becloud the retina, the screen on which the lens focuses its image of things seen. Often the retina itself is changed beyond recognition: doctors are far from agreement on the signs of the disease, and some wonder whether they are dealing with two or more diseases.

RLF & Prematures. RLF has mushroomed from an almost unknown disease ten years ago to a major cause of blindness in children up to kindergarten age. Every year the estimate of infants who will lose their sight because of RLF has to be raised; it now stands at 650 annually in the U.S., and the numbers are increasing in British Commonwealth countries and in Europe. Some of the increase was to be expected because RLF strikes almost exclusively among premature babies (mainly those weighing 4 Ibs. and under), and the number of these who now survive, thanks to more and better incubators, has been rising steadily. But strangely, the number of RLF cases is going up faster than the survival rate of prematures.

One of the most disheartening features of the battle against the disease is that so many promising trails, seeming to lead toward a cure, suddenly come to a dead end. Two researchers in Boston (where the disease is inexplicably commoner than in most cities) thought they had the answer in unbalanced iron and vitamin rations given to prematures. In Baltimore, Drs. William and Ella Owens seemed to get good results in arresting the disease with a vitamin E preparation (TIME, Aug. 29, 1949), but other doctors could not duplicate their results. Some eyemen report

ACTH and cortisone have checked RLF; others differ.

Is Oxygen an Answer? Many doctors have wondered whether the oxygen given to incubator babies somehow caused RLF ; or perhaps it was the way the babies were taken off oxygen -- slowly or suddenly. Dr. Thaddeus S. Szewczyk of East St. Louis (where RLF is rampant although it is rare across the river in St Louis) now reports that he has seen no lasting damage from RLF in premature babies since he started giving them a minimum of oxygen and tapering it off slowly.

Other doctors who have studied the oxygen problem doubt that these results mean anything. Said a St. Louis eyeman last week: "The more we learn about RLF, the less we know."

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