Retinopathy of Prematurity [ROP] Treatment and Management

What is ROP?

ROP is a potentially blinding condition caused by abnormal development of retinal blood vessels in premature infants, especially the ones with a low birth weight [less than 1250 grams] and born before 31 weeks of gestation.

How can it affect my baby?

ROP can threaten the vision if not picked up earlier. In majority, the ROP resolves with time. But in some, it can progress to severe stages which result in damage to the retina, ultimately leading to a retinal detachment leading to loss of vision.

What is ROP Screening?

ROP screening is mandatory for babies less than 1250 gram and those born before 31 weeks of gestation. It is often ignored or not done periodically as the eyes look normal from the outside. And parents, neonatologist cannot tell until the eyes are examined by a trained ophthalmologist with specialized equipment who is used to dealing with ROP. Not all ophthalmologists are trained to diagnose and treat this blinding condition.

What determines the severity of ROP?

Birth weight and gestational age are the most important risk factors for development of severe ROP. Other factors that are associated with the presence of ROP include anemia, poor weight gain, blood transfusion, respiratory distress, breathing difficulties and the overall health of the infant.

What are the stages of ROP?

ROP is described by its location in the eye (the zone), by the severity of the disease (the stage) and by the appearance of the retinal vessels (plus disease). Stage 1 of ROP is a demarcation line that separates normal from premature retina. Stage 2 is a ridge which has height and width. Stage 3 is the growth of fragile new abnormal blood vessels. As ROP progresses. the blood vessels may engorge and become tortuous (plus disease).

How do we treat it?

There are typically two options once it is determined that a child has reached treatable ROP. The first method is laser ablation which is applied to the immature portion of the retina. This method of treatment has been around for many years and is still the most common method of treatment.

The second method of treatment involves an injection of medication (Avastin or Lucentis have both been used) into the eye that stops a signal that is causing the abnormal blood vessels to form. These medications may be used as an alternative to, or in addition to, laser treatment. The injection is a newer treatment. While results have been encouraging, further research is being done to help determine long term safety, optimal dosage, and rates of recurrence of ROP.

The outcome of laser or medical treatment for ROP is usually favorable with the disappearance of abnormal blood vessels and resolution of plus disease.

Timely accurate diagnosis and timely laser treatment, is the key to preserve the vision in these young neonates. Otherwise eyes which progress with retinal detachment caused by ROP generally have a poor visual prognosis. Retinal detachment can be treated with vitrectomy and/or a scleral buckling procedure. Despite optimal treatment, some eyes with ROP progress to permanent and severe vision loss.

Where is there more information about retinopathy of prematurity?

1. National Eye Institute 

2. Association for Retinopathy of Prematurity and Related Diseases (ROPARD) to their Premature Baby’s Eyes

3. More technical information can be found on the EyeWiki Site Retinopathy_of_Prematurity