Retinopathy of Prematurity (ROP)

Retinopathy of prematurity (ROP) is an eye condition that happens in some babies who are born early. It causes blood vessels in a baby’s retina to form incorrectly. Severe cases can lead to damage that causes detached retinas or vision loss.

Fortunately, most babies born with ROP don’t need treatment and develop normal vision. But it’s still important to get diagnosed. An eye doctor or another healthcare provider will screen your infant for ROP if they’re born prematurely or have other risk factors. It’s most common in babies who are born before 31 weeks and/or weigh less than 3.3 pounds (1,500 grams).

ROP stages

Healthcare providers use stages to classify ROP’s severity. The stages range from 1 to 5:

• Stages 1 and 2: These stages are mild to moderate ROP that might not need treatment.
• Stage 3: Your child may need treatment to prevent retina damage or detachment.
• Stage 4: This is severe ROP that causes partially detached retinas. It will need treatment.
• Stage 5: This stage causes total retinal detachment. It also requires urgent treatment. And even with treatment, your child may have some permanent vision loss or blindness.

Your child’s provider may use a few other terms to describe ROP, including:

• Aggressive retinopathy of prematurity: A severe case of ROP that quickly gets worse
• Plus disease: Severe ROP that includes widened and wavy blood vessels in your child’s retina

Retinopathy of prematurity symptoms

ROP doesn’t cause noticeable signs or symptoms. Doing an eye exam is the only way to know an infant has it. That’s why your child’s healthcare providers will screen them for ROP if they’re born prematurely or have other risk factors.

Untreated ROP can lead to detached retinas. This can cause permanent vision loss.

ROP causes

ROP happens when a baby is born before their retinas are done developing. That’s where it gets its name. Retinopathy is retinal damage. So, retinopathy of prematurity is retinal damage that happens when a baby is born prematurely.

The retina is a layer of tissue at the back of your eye. It converts light into electrical signals that your brain uses to create your vision.

Your baby needs healthy retinas with proper blood supply to see the world around them. Blood vessels in their retinas develop throughout pregnancy. But they aren’t completely formed until close to birth. As a result, babies born prematurely don’t have fully formed blood vessels in their retinas. Those vessels continue to form after birth. But they may develop abnormally.

Risk factors

It’s not always possible to tell which babies will have ROP, but researchers know some factors raise a baby’s risk. Risk factors for ROP include:

• Delivery before 31 weeks (the earlier the delivery, the higher a baby’s risk of ROP)
• A low birth weight of less than 3.3 pounds (1,500 grams)
• Neonatal respiratory distress syndrome
• Bleeding in the brain
• Infections or other medical problems

If your infant has any risk factors, their healthcare provider will screen them right after they’re born.

How doctors diagnose ROP

Healthcare providers will notice any ROP risk factors when your baby is born. They’ll refer your child to an eye doctor for a screening. The screening will usually be four to six weeks after your baby is born.

Your child’s eye doctor will dilate their eyes with medicated drops. Then, they’ll give your infant a full eye exam. They’ll check your baby’s retinas for any signs of damage or unusual development.

Retinopathy of prematurity treatments

Treatment options for retinopathy of prematurity include:

• Laser therapy: An ophthalmologist will use a laser to create a pattern of safe, small burns on the outer edges of your baby’s retina. This prevents abnormal blood vessels from forming. Laser therapy successfully treats ROP about 90% of the time.
• Anti-VEGF therapy: This is an injection of medication into your baby’s eye. The medicine stops abnormal blood vessel growth.

Your baby’s eye doctor will tell you the pros and cons of these treatments and explain what’s best for your child’s eyes.

Your baby will need other treatments if they have a detached retina, like vitrectomy surgery. You may need to see a retina specialist.

What can I expect if my child has ROP?

Your infant’s healthcare provider will tell you if they’re at risk for ROP. Most babies born with it have lower-stage cases that don’t need treatment. And even if your baby needs ROP treatments, these are usually very successful.

But it’s important to get your child’s eyes examined as often as their eye doctor suggests. Your baby may need additional screenings every few weeks after they’re diagnosed with ROP. They’ll need follow-up exams even after you bring them home.