Retinopathy of Prematurity

ropRetinopathy of Prematurity (ROP) is a disease that occurs in some premature babies. It is the growth of abnormal blood vessels in the retina that generally begins during the first few days of life and may progress rapidly to blindness over a period of weeks. This process occurs because the eye is rapidly developing during gestational weeks 28-40. The blood supply to the retina starts at the optic nerve at about 16 weeks gestation and blood vessels grow out from there, toward the edges of the retina until the time of birth. When a baby is born prematurely, this normal vessel growth stops and as a result new abnormal vessels begin to grow. Over time this vessel growth produces a fibrous scar tissue which attaches to the retina and the vitreous gel. This ring may extend 360 degrees around the inside of the eye. If enough scar tissue forms, it can begin to cause a retinal detachment, and in some cases, causing blindness.

Signs and Symptoms

  • Low birth weight (3.5 pounds or less)
  • The need for any oxygen within the first week after birth
  • Unstable health immediately after birth

Children with ROP as infants should be watched for:

  • Holding objects very close
  • Difficulty seeing distant objects
  • Favoring or winking one eye
  • Reluctance to use one eye
  • Poor vision (previously undetected)
  • Sudden decrease of vision
  • Crossed or turned eye

Detection and Diagnosis

Premature infants at risk for ROP should have an ophthalmic examination at approximately 4-6 weeks of birth. After instilling a series of dilating drops in each eye, the doctor examines the retina with an ophthalmoscope. ROP is diagnosed by stages of developmental growth.


Treatment

Infants with stage I or stage II ROP usually will not require treatment, as these stages often resolve over a period of weeks. If ROP progresses to stage III, or if abnormal blood vessels form, laser surgery may be needed. The laser treatment causes the existing abnormal vessels to die and discourages the formation of new ones, preserving the baby’s vision. Regardless of whether treatment is required, children should be re-examined at recommended intervals to determine if the progression of the disease has halted, or whether additional treatment is required.