R.LF.

Medical skill has made dramatic gains during recent years in saving the lives of premature babies, but along with this advance a disturbing fact was noted: among babies weighing less than three pounds at birth, about one out of eight went blind, usually in both eyes. Those weighing three to five pounds were less susceptible. By one estimate, the price of the advance in science was that 500 U.S. babies a year might be afflicted.

Seven years ago the disease was described and tagged with the forbidding name of retrolental fibroplasia--because it seemed to be a growth of abnormal, fibrous tissue behind the lens of the eye. Doctors could not agree on whether the disease was new, or had simply gone unnoticed. Some said that the tiny victims were born with R.L.F.; others that it developed later.

A young team of Baltimore eye specialists, Dr. William Councilman Owens and his wife, Dr. Ella Uhler Owens, decided to begin at the beginning. In 1945 they started to study every baby weighing 4 1/2 pounds or less born at Johns Hopkins Hospital or taken to its nursery. They observed 214 in two years. No baby had R.L.F. at birth, but five developed it.

Lens & Retina. Their most notable conclusion in this period: the fibrous tissue was not a foreign growth between the lens and the retina (the sensitive screen upon which the lens focuses images), but a swollen, greyish transformation of the retina itself. It occurred when the babies were between two and four months old.

Last spring, a young couple from New Orleans flew into New York City with twin boys who were already seven months old. Andrew Hoffmann and his pretty blonde wife thought both boys were blind, but at Presbyterian Hospital it was found that Dennis had some vision. On Kenneth, who had none, an ophthalmologist operated to remove part of the fibrous tissue. He believed that it was not the retina, but that the retina was shriveled and displaced. By last week, Dennis Hoffmann's vision was-improving slowly, but Kenneth was still sightless.

Meanwhile, the Owenses and two Boston researchers, Dr. V. Everett Kinsey and Dr. Leona Zacharias, had worked out a theory. Premature babies cannot digest fats and so do not get a natural supply of the vitamins (A, D, K and E) found in butterfat. To make up for this, some hospitals give them the vitamins, especially A, in water. Hospitals which use this treatment, the Bostonians reported, have a higher R.L.F. rate than others.

Iron & Vitamins. The Owenses went a step farther. Vitamin A apparently increases the infant's need for vitamin E, but at the same time it decreases the natural supply of E. In addition, iron added to the prematures' diet to prevent anemia destroys vitamin E. While practically nothing is known about the workings of vitamin E in the human body, this was a lead worth following up. The Owenses arranged to get a special preparation, d-1 alpha tocopherol acetate, rich in vitamin E, to be given in a water base.

Twelve babies, all three pounds or less at birth, were given vitamin E, beginning when they were about a week old. None of them has developed R.L.F. Of 17 others studied who did not get vitamin E, three began to show the early symptoms of the disease; so did four others who had weighed between three and four pounds. When vitamin A and iron were stopped, and vitamin E given to these seven, the disease was checked in four cases. This, cautioned Dr. William Owens, is "very encouraging, but not scientifically definite."

In a recent paper the Owenses warn: "Vitamin E supplements are of no value if not started...before the baby is six weeks of age, since by that time irreversible retinal changes have occurred." Thus in the case of the Hoffmann twins, it apparently was several months too late for vitamin E treatment when the babies were brought to New York. At Johns Hopkins, every baby under three pounds now gets alpha tocopherol when a week old, and until it passes the 5 1/2-pound mark.

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