Retinopathy of Prematurity
Retinopathy of Prematurity (ROP) is most common in premature babies with very low birth weights and can cause blindness if untreated.
What is ROP?
The retina is the layer of cells at the back of the eye, where visual pictures are formed and sent to the brain. It basically is what allows us to see. When a baby is born early, the blood vessels in the retina are still developing.
In most premature babies, the blood vessels develop normally. Retinopathy of prematurity (re-tin-ah-path-ee of pree-mah-toor-ih-tee), also called ROP, occurs when the immature blood vessels of the retina develop abnormally.
What Causes ROP?
The babies most at risk for having ROP are those with very low weights at birth. Other causes of ROP are not completely understood.
What are the Signs of ROP?
The only way to diagnose ROP is by looking inside the eye during a scheduled exam. These exams are carefully timed and are done by an ophthalmologist (eye doctor) who is trained in looking at the eyes of premature babies.
When are the First Eye Exams Performed?
Your baby will need to have eye exams if his/her birth weight was less than 1,500 grams or if he/she was born at 32 weeks or earlier. Other babies who have been on a ventilator or have other risk factors for ROP will be examined if the doctor feels it is necessary.
At 4 to 7 weeks of age, babies at risk for ROP start receiving eye exams every 1 to 2 weeks in the hospital. The nurses and doctors in our NICU are trained to keep track of all the babies who need eye exams. The eye exams will continue until the blood vessels in the retina are fully developed (mature). Keep in mind that the vessels may not mature until your baby is discharged from the hospital. If this is the case, eye doctor visits will be needed after discharge.
How are the Eye Exams Performed?
The eye doctor performs the exams with the help of a nurse in the NICU. Before the exam, drops are placed in each of the baby's eyes. These drops dilate the pupils. The doctor may use an "eyelid speculum" to hold the eyelid open for the exam. He then uses a special lens that sends a bright light into the eye. The doctor can then see and examine the retina.
During the exam, your baby will be carefully monitored. The exam is done quickly so that discomfort is minimal. It is not uncommon for the eyelids to be red or slightly swollen after the exam. There may also be red areas in the white part of the eye. These changes are only temporary, but the red areas may take several weeks to disappear.
What is the Treatment?
ROP is classified by the location of the abnormal blood vessels (zone) and the stage of changes. Treatment depends on the stage. The doctor will tell you the results of the exam and explain any needed treatment.
Stages 1 and 2 (Mild to Moderate)
No treatment is needed in this stage. The abnormal blood vessels will usually heal sometime in the first 4 months of life. Regular exams will be done until the blood vessels are fully mature.
The retina vessels are more abnormal at this stage. Healing may occur without treatment, or laser treatment may be used to prevent ROP from getting worse. Eye exams will be done more often so the treatment can be done at the right time. This will reduce the risk of future blindness.
Stages 4 and 5 (Most Severe)Scars form in the retina and pull on it, causing part of or the entire retina to separate from the back of the eye. This is called retinal detachment. This can cause severe vision loss or blindness. Surgery may be done to try to reattach the retina and save some vision.
What do you need to Do?
Untreated ROP causes blindness. Your baby needs the carefully timed exams, so that treatment can be done at the right time. If your baby goes home before the exams are complete, follow-up will need to be done in the eye doctor's office. Please see your baby's discharge instruction sheets for the date and time of the next appointment. If you have questions, please discuss them with your baby's doctor before you go home from the hospital.
Be sure to keep your baby's scheduled appointments for eye exams. Missing appointments is a great risk to your baby's vision. If you cannot keep the appointment, call the eye doctor's office right away and reschedule it as soon as possible. It is important the treatment be done right away if necessary.
This information is not specific to your child. It is only a general guide about ROP. If you have questions, please call your baby's eye doctor or speak with one of our neonatologists. you may also obtain other information form the American Academy of Opthalmology at www.aao.org.