Retinopathy of Prematurity

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Retinopathy of Prematurity (re tin OP uh thee of pree mah TURE i tee), also known as ROP, is an eye problem for which premature babies are at high risk. Doctors who specialize in the care of children's eyes (pediatric ophthalmologists) examine the eyes of babies who are at risk for ROP.

What ROP Is

blood vessels in the retina

When babies are born early, the blood vessels in the back of the eye have not fully grown. They need to finish growing so the retina can get the oxygen and nutrients it needs to work right.

The retina is the inner lining on the inside back part of the eye. A healthy retina is required for good vision. (If the eye were a camera, the retina would be the film – the part that captures the image.)

The smaller the baby, the more likely he or she is to develop ROP. For example:

  • More than 80 per cent of infants who weigh less than 2 pounds, 3 ounces at birth get ROP.

  • Only about half of infants whose birth weight is up to 2 pounds, 12 ounces get ROP.

  • If a baby weighs more than 3 lbs., 8 oz. at birth, his or her chance of developing ROP is very, very small.

How ROP Affects My Baby

After birth, the immature blood vessels of the retina continue to grow. About 4 to 8 weeks after birth the vessels may start to grow abnormally. When this happens, it is called ROP. Most babies with a mild to moderate form of ROP see normally for their age. Fortunately, for most babies, mild to moderate ROP goes away without scarring or vision loss. It is only when ROP progresses to the most severe stages that vision is in danger. The worst outcome of ROP is a detached retina and total blindness. No one can predict which babies will do well and which ones will develop significant problems. That is why all low birth weight infants need to be examined and monitored for ROP.

The ROP Exam

  • Dilating drops will be given to your baby. This allows the doctor to see through the pupil to the blood vessels during the exam.

  • Babies cannot hold their eyes open for an eye exam, so a speculum is needed to open the eye. The speculum is a rounded instrument that holds the eye open during the exam. A depressor is an instrument used to direct the eye so the doctor can see into the eye better. Both of these instruments only go on the outside of the eye between the eye and the lid. They do not poke or puncture the eye. They are removed immediately after the exam is over. The infant feels pressure, not pain.

  • The bright light that is needed to see through the lens is also irritating to the infant. He or she will cry. However, it will be a quick exam and you can offer comfort right after the exam. The light will not harm your infant but you can shade him after the exam if you wish.

  • Your infant’s eyes will stay dilated from 3 to 8 hours after the procedure. Then pupils will return to normal. You may notice the baby closing his eyes more until the medicines wear off.

The Treatment for Severe ROP

If your baby shows signs that ROP is getting worse, the ophthalmologist may recommend treatment. If ROP is left untreated, it can cause retinal detachment, vision loss, and even blindness. Of the 14,000 babies who are diagnosed with ROP each year, about 1,000 to 1,500 require treatment.

Right now, there are two types of treatment for ROP. Both require an admission, anesthesia, a procedure, and monitoring after the procedure until your infant is stable and ready to come home.

The two types of treatment are:

  1. Laser: Laser surgery stops the growth of abnormal blood vessels by scarring areas on the peripheral retina. This eliminates pulling on the retina and the risk of detachment. Many tiny laser marks are created on the eye. Each eye takes about 30-45 minutes to complete. There is no incision (cut).
  2. Avastin: Avastin is a medicine that is injected into the eye. It blocks the production of a chemical that is causing the abnormal blood vessels to grow in the eye. Blood vessels resume normal growth, but still need to be monitored for a while after the injection.

What to Expect after Surgery: You may notice redness of the eye and puffy eye lids for 1 to 3 days. Your infant should have minimal pain. You should call IMMEDIATELY for fever greater than 101 degrees F, increased pain signals, increasing redness of the eye or drainage from the eye.

Eye drops may need to be given at home for 2 weeks or so. These eye drops are very important to help the eye heal. Your doctor will tell you what medicines to give and how often.

Research to Prevent ROP 

Modern medical care in the NICUs and special care nurseries has helped smaller babies survive. Because there are more premature infants than ever before, doctors are also seeing more ROP.

Research on ROP is currently being done here at Nationwide Children’s. These research projects study the treatment of severe ROP and the outcome of children with mild or moderate ROP. Children whose ROP does not require treatment usually have good vision. Rarely, they can be affected by the same scarring and retinal detachments that affect eyes with severe ROP. Some children who have had ROP need glasses sooner than children who were not premature and did not have ROP. We hope someday to prevent all vision loss from this disease.

Follow-up Appointments

Follow-up appointments after surgery are VERY important to monitor the treatment and progress of your infant’s eyes. When your baby is sent home, be sure to ask your doctor or nurse when your follow-up appointment will be. These appointments could be daily or weekly at first and then will be less frequent if your infant is doing well. The timing of exams is important. Missed appointments could delay needed treatment.

It is very important that you give your current phone number and address to your child’s care team so the ophthalmologist’s office can contact you about appointments and updates on your infant.

If you have questions or need to make an appointment for your child, please call the Eye Clinic at 614-722-4076.

Retinopathy of Prematurity (ROP) (PDF)

HH-I-276 1/07 Revised 7/15 Copyright 2007, Nationwide Children’s Hospital