Patient education: Retinopathy of prematurity (ROP)
(The Basics)

What is retinopathy of prematurity?

Retinopathy of prematurity (also called “ROP”) is an eye condition that happens in babies who are born very early. In ROP, extra blood vessels grow inside the eye. They can damage the tissue at the back of the eye, called the “Retina“. This part of the eye contains the cells that react to light. Damage to the retina can cause vision problems and even blindness.

Incidence — ROP affects a substantial number of preterm infants worldwide. Both the incidence and severity increase with decreasing gestational age (GA) and birth weight (BW)

ROP usually gets better as the baby grows. But if ROP is severe, some babies might need treatment.

Which babies are at high risk

Risk factors — The most important risk factor for developing ROP is prematurity. Others are low BW, low GA, assisted ventilation for longer than one week, surfactant therapy, high blood transfusion volume, cumulative illness severity, low caloric intake, hyperglycemia, and insulin therapy, which have been independently associated with higher rates of ROP.

Who should be screened?

Screening criteria — We suggest screening all infants with birth weight (BW) ≤1500 g or gestational age (GA) ≤30 weeks, as well as those with BW between 1500 g and 2000 g or GA >30 weeks whose clinical course places them at increased risk for ROP (as determined by the neonatologist).

What are the symptoms of ROP?

ROP does not usually cause symptoms. But doctors check for ROP in all babies who are born very early.

 Is there a test for ROP?

Yes. An eye doctor can do an exam to check for ROP. Before the eye exam, the doctor or nurse will put drops in the baby’s eyes to make the pupils bigger. This is called “dilating” the pupils. This is to make sure the eye doctor can see the retina. Some hospitals check for ROP by taking pictures of the baby’s eyes. The pictures are then sent electronically to an eye doctor who can tell if there are signs of ROP.

A baby might not need an eye exam until they are 4 to 8 weeks old. After the first exam, an eye doctor will probably check your baby’s eyes every 1 to 3 weeks. They can check to see if the ROP is getting worse or better. If it gets worse, your baby might need treatment.

How is ROP treated?

Some babies do not need any treatment for ROP. However severe ROP needs treatment. If severe ROP is not treated, it can cause blindness.

There are two procedures that doctors can use to treat ROP:

• “Laser photocoagulation” – This treatment uses a powerful light called a “laser” to seal or destroy the extra blood vessels. Babies often need general anaesthesia for this procedure. This involves giving medicine to put the baby to sleep so they won’t move and won’t feel anything during the procedure.
• Anti-VEGF injection – This treatment involves injecting the eye with special medicines called “anti-VEGF” drugs. These medicines stop the extra blood vessels from growing. Most babies don’t need general anaesthesia for this procedure. The doctor uses a numbing medicine on the eye before the injection.

The decision of which procedure is used will depend on your baby’s condition and how severe the ROP is. Your doctor will talk to you about which procedure is right for your baby.

Sometimes, ROP pulls the retina out of its normal place in the eye. When this happens, it is called a “retinal detachment.” Doctors can do surgery to try to put the retina back in place. But there might be too much damage for surgery to fix it completely. If this happens to your baby, they might not see well from that eye.

Can ROP be prevented?

Right now, doctors do not have a good way to keep babies from getting ROP. Feeding your baby breast milk can help protect them from getting ROP. Breast milk has other benefits for babies, too.

If your baby needs eye exams to check for ROP, make sure you go to all the appointments. If you do this, your baby can get treatment for ROP if they need it.

– Dr. Suvarna Dangle

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