Retinopathy of Prematurity

ExitCare ImageRetinopathy of prematurity (ROP) is an eye disease in some premature babies. In ROP, new blood vessels overgrow in the tissue that captures images in the back of the eye (retina). If the blood vessels grow too much, the retina may deform or detach (pull away from the back of the eye). ROP can lead to loss of vision. The amount of vision loss, if any, is determined by the amount of damage to the eye. Most cases clear up without damage to the retina.

CAUSES

The cause of ROP is not known. It is known that the more premature a baby is, the higher the chance for ROP. If a premature baby is exposed to a high amount of oxygen, this may increase the risk of ROP.

SYMPTOMS

There are no symptoms of ROP.

DIAGNOSIS

Eye drops are put in the eyes to enlarge (dilate) the infant's pupils. An eye doctor (ophthalmologist) will examine the eyes with a lighted instrument. This exam should be done on all newborns born before 30 to 32 weeks of gestation, or who weigh about 3 pounds or less. It is wise to have an ophthalmologist check the retinas every 1 to 3 weeks until the blood vessels of the retina appear to have developed normally.

TREATMENT

  • Mild ROP does not usually need treatment. It often either stops or gets better. However, mild disease can worsen into severe disease in the newborn. Severe forms of ROP need treatment.

  • When treatment is done depends on the type of ROP and the location of the disease in the retina. There are 2 treatments for ROP: laser phototherapy or cryotherapy (freezing). Normally, only 1 treatment is needed, but it is important that the ophthalmologist continue to check your baby's eyes. Laser phototherapy is the most common treatment.

  • In laser phototherapy, the ophthalmologist directs a laser beam through the pupil. The beam is used to destroy many tiny areas of the peripheral retina. This prevents the worsening of the ROP. This procedure can be done in the nursery with portable equipment.

  • In cryotherapy, the ophthalmologist uses a small pen-like instrument to briefly freeze the sides of the retina by applying the instrument to the side of the eye.

  • If ROP causes bleeding inside the eye or detachment of the retina, eye surgery may be necessary.

Even with successful treatment of ROP, other factors may lead to less than normal vision in premature infants. With or without ROP, there can be vision loss due to:

  • Lazy eye (amblyopia).

  • Eye misalignment (strabismus).

  • Damage to the brain from bleeding and poor oxygenation in the neonatal period.

  • Nearsightedness (myopia) or other vision problems needing glasses or contacts.

HOME CARE INSTRUCTIONS

Because of the possibility of delayed eye problems, every premature infant should be watched for vision problems throughout life.