Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a condition that can only occur in premature infants and is characterized by abnormal blood vessel development on the retina of the eye. It usually affects both eyes.

Blood vessels in the eye normally finish developing a few weeks before birth. If a child is born prematurely, the blood vessels of the eye may not be fully formed.

About 90 percent of all infants with ROP have a mild to moderate case that does not require treatment but does need careful monitoring. In these infants, their condition improves and leaves no permanent damage. However, infants who have more serious cases can face long-term effects, including mild to severe vision loss or blindness.

If your baby weighs 2.75 pounds or less and is born before 31 weeks gestation, he or she has a higher risk for ROP. (The normal gestation period for a full-term pregnancy is 38 to 42 weeks.)

In addition to birth weight and gestation period, other factors may affect the risk of developing ROP, including:

Anemia
Poor weight gain
Blood transfusions
Use of supplemental oxygen after birth
Vitamin E deficiency
Race (Caucasians are at higher risk than African-Americans)
Respiratory complications or breathing difficulties
Overall health of infant

There are five stages of the disease, ranging from Stage 1 (mildly abnormal blood vessel development) to Stage 5 (total retinal detachment). Most babies who develop ROP have Stages 1 or 2. For babies with Stage 3 or worse, an ophthalmologist may recommend treatment.

Diagnosis of Retinopathy of Prematurity

An eye exam by an ophthalmologist can diagnose retinopathy of prematurity. Ophthalmologists at Riley at IU Health have experience with diagnosis and treatment of serious eye diseases such as retinopathy of prematurity. Pediatricians refer their young patients to us with confidence that they will receive high-quality, child-friendly care and advanced diagnostic and surgical procedures, if needed.

Premature babies are screened for ROP and all other at-risk illnesses shortly after birth while still in the Neonatal Intensive Care Unit at Riley at IU Health.

Screening for ROP should be done for all babies born before 30 weeks or weighing less than three pounds at birth. Some high-risk babies who weigh 3 to 4.5 pounds or those born after 30 weeks may also be screened.

ROP may go undetected until several weeks after birth in some babies. Parents of premature infants at risk of ROP should schedule an appointment with a pediatric ophthalmologist four to six weeks after birth.

Treatments

Most infants do not need treatment; however, for those who do, early treatment improves a child’s chance for normal vision. Even with optimal treatment, some children with ROP may have permanent and severe vision loss.

The most effective treatments for ROP are laser therapy or cryotherapy. These treatments are performed only on infants with advanced ROP, particularly Stage III with “plus disease”—which means the blood vessels are enlarged or twisted and the condition is getting worse. Treatment is designed to slow or reverse the abnormal growth of blood vessels, but these treatments can also damage some peripheral vision.

The outcome of laser treatment is usually good, and abnormal blood vessels often slowly disappear. In some cases, ROP can worsen and the retina may pull away from the back of the eye leading to a retinal detachment. Vitrectomy and/or a scleral buckling procedure may be needed to treat a retinal detachment. When ROP causes retinal detachment, children are less likely to have favorable outcomes, and some infants may experience serious vision loss.

Researchers are studying the effects of medications as an alternative to or in addition to laser treatment, including injecting certain medicines into the eye.

Treatment for ROP does not always prevent vision loss. Some babies may not respond to ROP treatment, and the disease may get worse. Infants with ROP also have a higher risk for developing certain eye problems later in life, such as:

Myopia (nearsightedness)
Late retinal detachment
Amblyopia (lazy eye)
Strabismus
Glaucoma
Vision loss or blindness

If your child is diagnosed with ROP, he or she should have eye exams with an ophthalmologist until the abnormal blood vessel growth resolves on its own or is treated.

Key Points to Remember

Retinopathy of prematurity is a condition in premature infants where the retina of the eye develops blood vessels in an abnormal way.
In most cases, babies have mild to moderate ROP and do not need treatment.
Infants who develop more severe cases of ROP can have mild long-term effects that require glasses, surgery, or serious lifelong vision loss including blindness.
Prematurity is the greatest risk factor for ROP.
All babies who are born before 30 weeks gestation, weigh less than 3 pounds at birth or who have other risk factors should have an eye exam a few weeks after birth by an ophthalmologist experienced in ROP.
Laser treatment is the most common treatment for infants with advanced ROP.
Regular, long-term follow-up with an ophthalmologist is needed to monitor ROP and watch for other eye conditions that may develop.

Support Services & Resources

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

FamilyDoctor.org

This website is supported through the American Academy of Family Physicians and has information for the public about common health complications that affect premature infants, including retinopathy of prematurity.

National Eye Institute (NEI)

The NEI, which is part of the National Institutes of Health (NIH), conducts and supports research, provides training and shares health information for parents and caregivers about eyesight and eye conditions.

American Academy of Ophthalmology

The American Academy of Ophthalmology is the largest national membership association of eye doctors. Their EyeWiki™ website contains recent research on the diagnosis and treatment of retinopathy of prematurity.

Retinopathy of Prematurity Research

Our physicians are committed to excellence in pediatric ophthalmology care, demonstrated through participation in research at the Indiana University School of Medicine. Recent research explores the use of intraocular lens and secondary Artisan lens implants in children as a treatment for cataracts, new drugs to treat glaucoma, new therapies for macular degeneration and treatment of strabismus. We have also completed research in molecular biology of the chemical cycle of vision, neurophysiology of eye movements and physiology of blood flow in the eye.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.