Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a disorder of the retina (the light-sensitive part of the inside of the eye) and only occurs in very premature babies. Generally, the more premature the baby and the lower the birthweight, the greater the risk for developing ROP.

The retina is the thin layer of light-sensitive nerve fibers and cells that covers the inside and back of the eye. In a premature baby, the central retina is established but the peripheral retina and its blood vessels are not completely developed until the baby reaches full term. The retina and its blood vessels may develop abnormally as they grow due in part to excessive growth factors being produced by the undeveloped retina. The abnormal growth of the vessels may lead to bleeding, scarring and retinal detachment. These problems may result in severe vision loss.

There are five stages of ROP, from a mild Stage 1 to severe Stage 5 when the retina completely detaches in the eye. Fortunately, about 90 percent of babies with Stage 1 and 2 ROP will self-resolve without treatment. However, many of the babies with Stage 3 and most of those with Stage 4 may develop serious eye damage. Each year, approximately 400 to 600 children are blinded by ROP.

Management of Retinopathy of Prematurity

In 2001, the American Academy of Pediatrics (AAP), the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) and the American Academy of Ophthalmology made recommendations for babies at risk for ROP. These guidelines have been continually updated and include the following:

• Eye examination, by a qualified ophthalmologist, for low birthweight and/or premature babies who are at risk for ROP
• Eye examination should be done at 30 to 31 weeks gestational age or 4 weeks after birth whichever date comes later
• Follow-up eye examinations at appropriate times until the risk of severe ROP subsides
• Considering babies with severe categories of ROP for treatment within 24 hours of diagnosis

How Is Retinopathy of Prematurity Treated?

Early diagnosis of damage is important in the treatment of ROP. Babies who develop severe ROP may benefit from a laser photocoagulation treatment to the retina to induce regression of abnormal blood vessels and to prevent further damage from occurring. The laser treatment involves placing laser spots on the peripheral undeveloped retina. This stops the undeveloped retina from producing the excessive growth factors that promote the retinopathy. Another treatment may be the injection of a medication into the eye that also reduces the growth factors that promote retinopathy. Although these treatment are successful for the majority of patients, a few patients may not do well and may still need further surgery. Even with successful surgery, the baby will need to have continued care with a pediatric ophthalmologist.