What is Retinopathy of prematurity (ROP)?

This is an example of an eye exam being performed on a baby. This is exactly what our exams were like.
This is an example of an eye exam being performed on a baby. This is exactly what our exams were like. | Source

The American Academy of Pediatrics defines Retinopathy of prematurity as an eye disease where the retina is not fully developed in the eye. It is also the abnormal development of blood vessels in the eye, commonly affecting premature babies. In a normal pregnancy, the eyes begin to form 3 months after conception, completing the development by the normal due date. If a baby is born prematurely, the growth and development of these vessels can be interrupted or change course.

The blood vessels should develop around the outside of the eye, but in ROP, blood vessels either stop growing or they turn inward toward the center of the eye. This abnormal growth can have extreme consequences if left unchecked.

Who is at risk for ROP?

Infants born before 30 weeks gestation and those that weigh less than 3 pounds face the highest risk of ROP. Babies who suffer from apnea, heart disease, CO2 in the blood, low blood oxygen, and respiratory distress may also be screened for ROP.

What to expect if your baby has ROP

ROP has 5 Stages:

Stage I: There is mildly abnormal blood vessel growth.
Stage II: Blood vessel growth is moderately abnormal
Stage III: Blood vessel growth is severely abnormal
Stage IV: Blood vessel growth is severely abnormal and there is a partially detached retina
Stage V: There is a total retinal detachment

If your baby is in a NICU or special care nursery, her caregivers will have her screened for ROP if the risk factors are there. An exam takes roughly 5-10 minutes. Your baby's eyes will be held open with lid speculum to keep her from blinking. Her eyes will be dilated, as well as numbed so she won't feel the instruments in her eyes. A nurse should swaddle and hold her as the doctor performs the exam. Be prepared, you baby will be extremely upset about the entire process, but its usually because they're being held against their will and not from pain.

Treatment Options

Most cases clear up on their own as the baby develops, but if it is determined that your child will need to have the blood vessel development treated, these are some options that you may be presented with:

  1. Cryotherapy - The application or use of extreme cold to freeze the vessels to prevent them from spreading inward
  2. Photocoagulation - A laser therapy that stops the blood vessel from growing, but must be used before scarring or detachment has occured
  3. Surgery will be performed if there is total retina detachment

Our daughter was born at 29 weeks, and she was screened for ROP at 4 weeks after birth. She was diagnosed with Stage II ROP and received eye exams every 2 weeks while in the NICU, and every 2-3 weeks once she came home. Her risk factors were 29 weeks gestation, weighing less than 3 pounds, and requiring long term oxygen support during her NICU stay. She is now 5 months old, and her doctor has confirmed that her eyes have developed normally. She will continued to be screened every 6 months now, as there are other eye problems she could be prone to just by being a preemie.


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