Retinopathy of prematurity

ROP, or retinopathy of prematurity, is an eye disease that affects babies born prematurely (born early) or who weigh less than three pounds at birth. ROP occurs when abnormal blood vessels grow in the retina.

Some cases of ROP in babies are mild and get better without treatment, but some babies need treatment to prevent blindness and protect their vision.

Stages of ROP

ROP has five different stages. Doctors use these ROP stages to determine the severity of the condition. These stages range from stage 1 (mild) to severe stage 5.

• Stages 1 and 2

  Babies in stages 1 and 2 of ROP often get better without treatment and can have healthy vision. Doctors carefully watch the baby at these stages to determine if the condition is worsening.

• Stage 3

  Some babies who develop stage 3 ROP get better without treatment and have healthy vision, but other treatments prevent abnormal blood vessels from damaging the retina, resulting in retinal detachment, an eye problem that leads to vision loss.

• Stage 4

  Babies in this stage have partially detached retinas and require treatment

• Stage 5

  At this stage, the retina is completely detached and even with treatment, babies may have blindness or vision loss.

Stages 4 and 5 are very serious, and babies in these stages require surgery. However, vision loss may still occur even with treatment, so doctors often start treatment at stage 3 of ROP.

It is also possible for babies in any stage of ROP to experience quick deterioration and need treatments. This makes follow-up exams on a schedule important. Diagnosing and treating ROP early is best to reduce the risk of more serious problems.

Symptoms of ROP

ROP causes no visible signs, but in advanced cases, the retina may partially or completely pull away from the normal position at the back of the eye. This is known as retinal detachment and may result in vision loss and blindness.

If your baby had ROP that resulted in damage, you might notice these later on:

• Their eyes do not follow objects
• Their eyes shake, wander or make unusual movements
• They experience difficulty recognising faces
• Their pupils look white

Babies who had ROP are also likely to have other eye problems as they age, such as:

• Crossed eyes
• Nearsightedness
• Retinal detachment
• Amblyopia (lazy eye)

Regular eye exams and check-ups are important for a child who has ROP when younger. Early diagnosis and treatment of eye problems help protect your child's vision as they age.

Can my baby have ROP?

Babies born before week 30 of pregnancy or weighing below three pounds at birth are at risk for ROP. An eye specialist will check if your baby is at risk of this condition.

Babies are also likely to develop ROP if they have:

• Infections or other medical issues that a premature baby may have, such as problems with their brain, lungs or heart
• Breathing problems and if they get excess oxygen therapy for breathing problems

Causes of ROP

Usually, the retina's blood vessels begin to develop in the fourth month of pregnancy and complete development around the due date or the ninth month of pregnancy. If your baby is born too early, the blood vessels may stop normal development, and the retina may develop abnormal blood vessels. This is known as retinal neovascularisation (NV).

These abnormal blood vessels in the retina can grow in the wrong direction, and because the blood vessels are attached to the retina, if they grow too far in the wrong direction, they may pull the retina from the back of the eye. This causes a type of retinal detachment.

How can a doctor check for ROP?

If your baby has a risk of ROP, the eye doctor will perform a dilated eye exam a few weeks after the child is born, usually 4 – 9 weeks after birth. You can ask your doctor when your baby should get the eye exam before leaving the hospital.

During your exam, the eye doctor will give your baby eye drops to widen the pupils. The eye doctor will check the baby's eye for any problem, especially the retina.

The eye doctor will decide if a follow-up exam is necessary based on their finding during the first exam. If your baby requires follow-up care, the doctor will re-check their eye every 1 – 3 weeks until they are sure there is no risk for retinal detachment.

Ensure you schedule your baby's follow-up exams so the doctor can detect ROP in the early stages and start treatment.

Treatment for ROP

In most cases, ROP in babies is mild, and they get better without treatment. However, some babies still need treatment to prevent ROP from becoming worse. Getting treatment early is important to protect the baby's vision. The treatments include:

• Laser treatment

  Advanced cases of ROP require laser treatment on the sides of the retina. The treatment can prevent the ROP from worsening and protect your baby's vision.

• Injections

  The doctor can also inject anti-VEGF drugs into the baby's eye. The medicine help block the growth of the abnormal blood vessels.

• Eye surgery

  Babies with completely or partially detached retinas (stage 4 or 5) have two types of retina surgery available to them.

Scleral buckle surgery – Your doctor will place a flexible band around your baby's sclera (the white area in the eye). This band will support the detached retina until normal eye growth starts, and the doctor will remove it.

Vitrectomy – the doctor will create small openings in the eye wall to remove most of the vitreous (the gel-like fluid that fills the eye) and replace it with a saline solution. The doctor will also remove the scar tissue on the retina and may carry out laser treatment to treat and seal the retina in place.

ROP surgery aims to prevent ROP from getting worse and causing blindness. Even with surgery, some babies with ROP may have blindness or vision loss.

At Optimal Vision, we perform eye exams on new babies to check for eye problems, including retinopathy of prematurity and recommend the necessary treatment. Visit our clinic today or contact us at 020 7183 3725 for an appointment with our eye doctor.