What is Retinopathy of Prematurity (ROP)

The eye functions much like a camera. The front of the eye contains the structures which focus the image and regulate the amount of light that enters the eye, similar to the lens and shutter of a camera. The retina in the back of the eye functions like the film in the camera. Without film, a camera cannot take a picture, and without a functioning retina, the eye cannot see.

ROP is a potentially blinding disease that affects several thousand premature babies each year in the United States, usually the smallest, youngest, and sick infants with compromised immune systems. When a baby is born prematurely, the retina is only partially formed. The blood vessels have grown into the retina at the very back of the eye but not into the rest of the retina.

There Are Three Stages of ROP

The first stage of ROP is when the blood vessels stop growing and form a line that separates normal from premature retina. In the second stage, the line of separation takes on substance as an elevated ridge of tissue. At this point, the eye is still capable of repairing itself. As the ROP advances into the third stage, fragile new abnormal blood vessels grow toward the center of the eye. If this third stage advances even more, the normal vessels dilate, indicating that the ROP may not go away on its own. This is known as “plus disease.” If untreated, ROP can cause the retina to pull away from the back of the eye (a retinal detachment), which can lead to blindness.

When Retinopathy of Prematurity develops, one of three things can happen:

In most babies who develop ROP, the abnormal blood vessels will heal themselves completely, usually during the first year of life.
In some babies, the abnormal blood vessels heal only partially. In these infants, nearsightedness, lazy eye, or a wandering eye commonly develop. Glasses may be required in early life. In some cases, a scar may be left in the retina, resulting in vision problems that are not entirely correctable with glasses.
In the most severe cases, which usually occur in the youngest, smallest, and sickest infants, the abnormal blood vessels form scar tissue, which pulls the retina out of its normal position in the back of the eye. This problem results in a severe loss of vision. Fortunately, there is treatment to minimize severe vision loss. In about 1 out of 4 babies, despite all treatment, this condition can lead to blindness.

Retinopathy of Prematurity Eye Exams For Babies

The eye exam involves dilating the baby’s eyes with drops. These are specially formulated for premature babies’ eyes. It takes one hour for the drops to work. Special tools are then used to open the baby’s eyes to examine very carefully. The baby might cry, however the eyedrops and tools are necessary and safe. Some parents choose to step out of the room during the exam as it can be hard for them to watch. The exam will need to be repeated every 1-2 weeks until 40-50 weeks gestation (the baby’s original due date or 1-2 months later).

Learn more about ROP: AAPOS – Retinopathy of Prematurity