Retinopathy of Prematurity (ROP)

Premature babies are at risk of ROP. This is a problem that can affect eyesight. ROP is the growth of abnormal blood vessels on the lining of the back of the eye (retina). In severe cases, the blood vessels can detach the retina from the back of the eye.

What causes ROP?

ROP occurs because the blood vessels on the retina are not finished growing until late in pregnancy. If a baby is born prematurely, these blood vessels aren’t fully developed at birth. So the blood vessels complete their growth after the baby is born. Factors in the environment outside of the womb may cause them to grow abnormally. One problem may be changing levels of oxygen in the blood. ROP is more likely in younger or smaller preemies.

How is ROP diagnosed and monitored?

All premature babies in the NICU (neonatal intensive care unit) have their blood oxygen levels closely monitored. Babies born less than  30 weeks gestation or weighing  1,500 grams or less (52.5 ounces or less) are examined by an eye care specialist (ophthalmologist). Eye exams can also be done by a trained member of the healthcare team using a special camera to look at the back of the eye. Some babies who weigh between 1,500 grams and 2,000 grams (52.5 to 70 ounces) but have other health problems may also need to have an eye exam because they are also at higher risk for ROP. Eye drops are used to expand (dilate) the pupil of the eye. This lets the healthcare provider look through the pupil to check the blood vessels on the retina. If the healthcare provider sees abnormal blood vessels, the ROP is rated from stage 1 (mild) to stage 5 (severe). The location of the blood vessels is also noted. The first exam may be done around 4 to 6 weeks after birth. Depending on the results of this exam and the baby’s gestational age, your baby will need follow-up exams every 1 to 2 weeks.

How is ROP treated?

Mild ROP (stages 1 and 2) often needs no treatment. Babies with moderate to severe ROP may need treatment. Several treatment options are available. Treatment usually depends on the severity of disease.

  • Laser surgery (laser therapy or photocoagulation). Your baby’s doctor uses laser beams of light to burn and scar the sides of the retina. This stops abnormal blood vessels from growing and prevents pulling on the retina.

  • Cryotherapy (freezing). Your baby’s doctor uses a metal probe to freeze and scar the sides of the retina. This prevents spread of abnormal blood vessels and pulling on the retina.

  • Scleral buckle. Your baby’s doctor puts a silicone band around the white of your baby’s eye (sclera). This band helps push the eye in so that the retina stays along the wall of the eye. The buckle is removed later as the eye grows. If it isn’t removed, a child can become nearsighted. This means he or she has trouble seeing things that are far away.

  • Vitrectomy. Your baby’s doctor removes the clear gel in the center of your baby’s eye (vitreous) and puts saline (salt) solution in its place. Your baby’s provider can then take out scar tissue, so that the retina doesn’t pull. Only babies with stage 5 ROP have this surgery

There are some newer injectable medicines being used to treat ROP, although the long-term effects of these are still uncertain. Talk to your baby's doctor about which treatment is best for your baby.

What are the long-term effects?

Many babies with ROP have no lasting effects. The more severe the disease, the higher the chance of permanent vision problems. The baby’s vision will most likely need to be evaluated within 4 to 6 months after leaving the hospital to see if glasses or eye exercises are needed. In rare cases, ROP can lead to blindness. 

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