Retinopathy Of Prematurity

Infants that are born prematurely can develop an eye condition called retinopathy of prematurity, also known as ROP. This is a condition in which the blood vessels in the back of the eye are poorly developed and the retina does not receive adequate blood flow. This can lead to a number of long term visual complications and needs close follow-up with a specialist. We work with local hospitals to both screen and treat ROP in premature infants.

What Should I Know About ROP?

ROP is a disease in which the blood vessels in the eyes of premature infants are underdeveloped. This disease can cause vision problems, including blindness in severe cases. Babies born before 31 weeks gestation and below 1250 grams (2.76 lbs.) are at the most risk. If your infant is at risk for ROP, you should get them screened. You should also make sure to get your infant’s eyes regularly examined by an ophthalmologist until the ROP goes away naturally, or treatment is determined to be necessary.

There are 6 stages of ROP, ranging from 0 to 5. Stage 0 is mild, and stage 5 is extremely severe. Stages 3 and up are considered severe. Stage 4 is where retinal detachment begins, and stage 5 is where it detaches completely. Retinal detachment is when the retina pulls entirely away from the back of the eye, and it has a high chance of causing blindness.

The appearance of blood vessels is also relevant in determining ROP severity. There is sometimes a condition present called Plus Disease, which is characterized by venous dilation and arterial tortuosity in blood vessels. In other words, Plus Disease can be identified by abnormally wide, wavy blood vessels in the eye. This is a sign of severe ROP.

Another way ROP is identified by is which zone of the eye it is in. There are 3 zones, with zone 1 being more likely to progress to severe stages than zone 2 or 3.

How Could ROP Affect My Infant?

Effects of ROP

Most cases of ROP are mild. The condition often resolves itself naturally, resulting in normal vision for the child. However, in severe cases ROP can progress to a dangerous stage where retinal detachment occurs, potentially causing permanent vision loss. Other less severe vision complications can also arise.

Who is most at risk?

Infants who are at the highest risk for ROP are born before 31 weeks gestation, and weigh less than 1250 grams (2.76 lbs.).

Other risk factors include difficulty gaining weight, anemia, difficulty breathing, the need for blood transfusions, and overall bad health.

How can I prevent ROP from getting worse?

Regular eye exams for infants after they are discharged from the hospital are critical in preventing ROP from becoming dangerous. If ROP progression is caught early, it can be treated sooner. This greatly increases the chances of preserving the baby’s vision.

ROP Diagnosis

Babies with risk factors for retinopathy of prematurity are recognized at the NICU by health professionals. Ophthalmologists will then perform screenings to check for ROP in infants at risk. These exams are needed until ROP resolves naturally, or it is determined that treatment is necessary. Proper timing for treatment is key in preventing ROP from causing permanent blindness.

During ROP exams, the baby is made comfortable and their eyes are dilated. The retina is then examined by an Ophthalmologist. They look for the which stage the disease is at, the appearance of blood vessels in the eyes, and the location of the disease in the eyes. All of these factors are considered in determining if the infant needs treatment.

ROP Treatment Options

When retinopathy of prematurity reaches a certain level of severity, treatment is needed. There are a couple of treatment options for ROP listed below. 

If the retina fully detaches, there are other surgical treatment options available, but they have limited success. If you treat ROP before retinal detachment has the chance to occur, the baby is far more likely to retain their vision. This is part of why regular eye exams for babies at risk are so important.

Option 1: Laser Ablation

Laser ablation is the most common treatment for ROP, and it is typically very successful. Lasers are used to remove the abnormal blood vessels.

Option 2: Injection Of Medication

In this treatment option, medication is injected into eye that stops abnormal blood vessels from forming. This treatment can be used on its own or in addition to laser ablation.

Other Resources

If you are interested in learning more about retinopathy of prematurity or other eye conditions that can affect infants and children, these are some helpful resources.