Retinopathy of Prematurity: What It Is, Causes, and Treatment

The last thing you want to hear when you take your newborn to the doctor is a complicated medical phrase. That’s especially true with premature infants, as they’re often more vulnerable to disease, including eye conditions. One such condition, retinopathy of prematurity (ROP), may sound scary, but it doesn’t have to be.

Let’s walk through the basics of ROP to give you the knowledge you need to support your baby. That way, you can spend time bonding with your newborn rather than stressing about their health. At Pair, we’re here to help.

What Is Retinopathy of Prematurity (ROP)?

Retinopathy of prematurity (ROP) sounds complicated — and from a medical perspective, it can be. However, if you break down its name into parts, the meaning is quite straightforward.

“Prematurity” refers to the age of patients diagnosed. As such, ROP is a condition that impacts babies that are born early, called premature infants or preemies. More specifically, this means they were before 37 weeks of pregnancy.

“Retinopathy” means that ROP is an eye problem that affects the retina. The retina is a layer of tissue toward the back of the eye, responsible for turning light into signals to be interpreted by your brain. By turning these electrical impulses into images, our brain (and retina) enable us to see.

Putting it all together, ROP causes a premature infant’s retina to create abnormal blood vessels. Typically, these blood vessels don’t cause problems or lead to any long-term concerns or vision loss.

What Causes ROP?

Retinopathy of prematurity is connected to the mother’s gestational age at the time of birth. Premature babies don’t have as much time to form fully, and because retinal blood vessels don’t develop until close to birth, your baby’s eyes are at a high risk for health issues related to birth time.

Additionally, your retinas require a healthy blood supply. Premature birth can mean these blood vessels aren’t fully formed, so as they continue to develop after birth, they might do so abnormally.

Your doctor won’t likely be able to predict if your baby has ROP, but it’s a known risk factor with premature births. If you give birth before 37 weeks, rest assured that it’s a concern your doctors are tracking. The more premature the birth, the more likely an infant is to be affected.

A low birth weight is another risk factor associated with ROP. Additionally, other health issues that affect premature births, such as respiratory distress, intracranial hemorrhage, and infections, may increase the likelihood of a baby developing ROP.

Is ROP Common?

ROP is fairly common, which is a silver lining to keep in mind. You can rest assured that your local neonatal intensive care unit (NICU) is familiar with this condition and will be looking out for any eye problems related to abnormal blood vessel growth.

Somewhere between 14,000 and 16,000 babies develop ROP yearly. The vast majority of these infants don’t require treatment (other than basic monitoring) and won’t experience any vision problems or future issues related to eye health.

A small percentage of affected infants, however, may develop severe ROP. Such cases of ROP can cause more serious issues, but we’ll talk about that more in a later section.

What Are the Signs of ROP?

There aren’t often signs or symptoms of ROP that will be noticeable to you. To spot it, your baby will likely need to visit an ophthalmologist and receive an eye exam. Neonatologists can also identify infants who are at risk and refer you to a pediatric ophthalmology practice for further evaluation.

How Is ROP Diagnosed?

Once your baby is identified as being at risk, you should head in for an eye exam. Your doctor might also refer to it as a “screening” since your baby won’t have been diagnosed yet. Typically, this visit will occur between four and six weeks after birth.

Once you’re there, your doctor will use eye drops to dilate your baby’s eyes. This will give them a better view of the part of the retina that ROP affects. They may also take digital pictures for clearer analysis.

Even if your baby isn’t diagnosed with ROP at that point, you may be asked to schedule follow-up visits until the retinal blood vessels are fully formed.

What Are the Stages of ROP?

If your baby is diagnosed with ROP, your ophthalmologist will assign it a stage. This is meant to help you and other doctors understand the severity of your baby’s case. As we mentioned, most cases of ROP are minor and don’t affect anything (other than your schedule for doctor visits).

That said, these follow-ups are crucial. You’ll want to keep an eye (pun intended) on whether or not the condition is progressing. Here are the stages of ROP:

Stages 1 and 2

In stages one and two, your infant has just been diagnosed. At this stage, it’s unlikely to cause any issues and will probably go away on its own.

Stage 3

Stage three is more likely to require treatment. You probably still won’t see any effects of the condition at this point — it’s more about preventing the condition from progressing to a more severe stage.

Stage 4

Stage four is considered severe or advanced ROP, and your baby may require treatment. Additionally, stage four ROP may lead to partial retinal detachment.

Retinal detachment occurs when the retina pulls away from its normal position. It is an urgent medical problem that can cause severe vision loss.

Stage 5

Stage five is the most serious stage. It can lead to a completely detached retina, and in especially severe cases, vision loss or blindness can occur even with treatment.

Additional Classifications

On top of a stage, your ophthalmologist may assign additional terms to your baby’s case. For example, aggressive retinopathy of prematurity is a severe case of ROP, even at early stages. It can progress more quickly than typical ROP.

Another classification is ROP plus disease. This is also a severe form of ROP when your baby’s retinal blood vessels are either too wide (dilated) or abnormally wavy (tortuous).

How Is ROP Treated?

If your baby’s ROP has progressed to a stage that requires treatment, you must take the condition seriously. While most infants who are diagnosed with ROP will not experience any problems, it’s not something you want to wait on.

Often, laser therapy is the go-to treatment for later ROP stages. Your doctor will use a laser to burn the outer edges of the retina, which in turn cauterizes the blood vessels and prevents them from forming. Laser treatment may sound alarming, but it’s often extremely effective at managing ROP.

The other common treatment is anti-VEGF therapy. Anti-VEGF treatment often takes the form of injections. These shots are inserted into your baby’s eye to stop the growth of abnormal blood vessels using medication.

How To Treat Retinal Detachment

If your baby’s ROP has progressed to retinal detachment, they may require additional treatment. You’ll likely be referred to a retina specialist who can recommend a specific treatment.

Laser therapy or cryotherapy are options in cases of partial detachments, and both are highly effective. If the retina has detached completely, your baby may require surgery, such as a vitrectomy, a scleral buckle, or a pneumatic retinopexy.

How To Live With ROP

We’ll say it again: Most babies with ROP recover completely without issue! That said, babies who have had ROP may be at increased risk for additional eye problems. These include amblyopia or lazy eye, strabismus or crossed eyes, and glaucoma.

Speak to your ophthalmologist about how to proceed once your baby has recovered. They’ll help you develop a schedule of eye exams to ensure their vision stays clear. After all, the earlier you spot potential issues, the more likely they are to be corrected.

Eyes on the Future

Hearing that your baby has an eye disease that might affect their vision is scary. It’s easy to spin out and stress, worrying about your baby’s future. While this initial diagnosis can be overwhelming, learning more about ROP and its treatments can help you achieve peace of mind.

With treatment, knowledge, and the necessary follow-ups, there’s no reason why you and your infant won’t be able to look toward the future — literally. For more resources to protect your eye health, trust the experts at the Pair blog.

Sources:

Retinopathy of Prematurity | Cleveland Clinic

Retinopathy of Prematurity | National Eye Institute

Retinal Detachment | National Library of Medicine

Anti-VEGF Drugs in the Prevention of Blindness | National Library of Medicine