Retinopathy of Prematurity

What is Retinopathy of Prematurity (ROP)?

ROP is a potentially blinding disease caused by abnormal development of blood vessels in the retina of premature infants.  The retina is delicate tissue on the inside of the eye that detects light and creates a visual message that is sent to the brain.  When infants are born early, the retina blood vessels have not completed their normal development.   In most cases, these vessels eventually grow correctly and ROP resolves without damage to the retina.  In some infants, the blood vessels grow incorrectly.  This can cause the retina to pull away from the back wall of the eye and lead to blindness.

How common is ROP?

About 14,000 infants have some degree of ROP, but for most (90%) of them it is mild and does not require treatment.  About 1,500 infants require treatment each year.  Every year, about 500 infants become legally blind due to ROP.

Which infants need to be checked for ROP?

An initial screening exams is recommended for all infants weighing less than 1500 grams (3 lb. 5 oz.) and those born before 32 weeks gestation.  Other infants identified by the neonatologist may also be checked.  Additional exams are scheduled based on the severity of the disease.  Often children are monitored weekly until they are a several months beyond their original due date.

How is ROP diagnosed?

The diagnosis of ROP is made by an ophthalmologist who examines the eye after the pupils are dilated.  Typically, the first examination is performed while the child is in the hospital.   The doctor uses a bright light and a special lens to look inside the eye.

Which infants need treatment?

Your eye doctor will determine the severity of the disease based on the amount of normal blood vessel growth, the appearance of the blood vessels, and the degree of abnormal vessel growth.  Severe ROP, called type 1, carries a high risk of vision loss and usually requires treatment.

How is ROP treated?

A laser is used to destroy the immature peripheral parts of the retina to protect the center part, which provides the good vision.  Most of the time, the blood vessels stop growing abnormally after laser and the retina does not detach.  Useful vision is often preserved in these cases, but premature infants can also develop other vision problems.  Retinal detachments in infants are treated with vitrectomy and/or scleral buckle procedures.  When retinal detachment occurs, the vision is often poor, even with successful surgery.  Injections of medicine into the eye are sometimes used for severe cases.

Why are eye exams recommended after discharge from the hospital?

It is VERY IMPORTANT to have timely eye exams after discharge from the hospital since the infant may still be a risk for blindness.  Often the ROP has not resolved before the child is ready to go home.  In these cases, the child must be examined soon after discharge.  Do not delay or miss this appointment.  If treatment become necessary, it is important to determine this early and to treat the infant at the right time.

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