Retinal Artery Occlusion (RAO)
Retinopathy of prematurity (ROP) is an eye condition that affects some babies who are born prematurely. In ROP, the blood vessels of the retina develop abnormally, which can lead to scarring, retinal detachment, and vision loss if severe cases are not treated promptly.
Most premature infants who develop ROP have mild disease that improves on its own without causing long-term vision problems. However, some infants develop more advanced forms of ROP that require urgent treatment to preserve vision.
Because ROP can progress rapidly, timely screening and close follow-up are essential.
What Is the Retina?
The retina is the thin, light-sensitive layer of tissue that lines the back of the eye. It converts light into signals that are sent to the brain through the optic nerve, allowing us to see.
Retinal blood vessels normally begin developing during pregnancy and continue to grow until shortly before full-term birth.
When a baby is born prematurely, normal retinal blood vessel development is interrupted. In some infants, the blood vessels continue to grow abnormally, resulting in ROP.
Which Babies Are at Risk?
ROP primarily affects premature infants.
The greatest risk is seen in babies who:
- Are born before 31 weeks of gestation
- Have a birth weight of less than approximately 1,500 grams (3.3 pounds)
- Require supplemental oxygen after birth
- Experience serious medical complications related to prematurity
Not every premature infant develops ROP, and not all infants with ROP require treatment.
What Causes ROP?
The exact cause of ROP is complex and not completely understood.
Several factors contribute, including:
- Premature birth
- Incomplete retinal blood vessel development
- Fluctuations in oxygen levels
- Medical conditions associated with prematurity
Abnormal retinal blood vessels may grow into the vitreous instead of along the retinal surface. These vessels can leak, bleed, and form scar tissue that pulls on the retina.
How Is ROP Classified?
ROP is described based on its location, severity, and the presence of abnormal blood vessel changes.
Stages of ROP
Stage 1: Mild Disease
A thin line develops between the vascularized and nonvascularized retina.
Most cases resolve without treatment.
Stage 2: Moderate Disease
The line becomes elevated into a ridge.
Many cases still improve spontaneously.
Stage 3: Severe Disease
Abnormal blood vessels begin growing into the vitreous.
Treatment may be necessary.
Stage 4: Partial Retinal Detachment
Scar tissue pulls part of the retina away from the back of the eye.
Stage 5: Total Retinal Detachment
The retina becomes completely detached.
This is the most advanced stage and can result in severe vision loss.
Plus Disease
Plus disease refers to increased dilation and tortuosity of retinal blood vessels and indicates more aggressive disease that often requires treatment.
How Is ROP Diagnosed?
ROP Screening Examinations
Premature infants who meet screening criteria undergo specialized retinal examinations performed by an ophthalmologist experienced in ROP.
These examinations usually begin several weeks after birth.
Dilated Eye Examination
The doctor evaluates:
- Retinal blood vessel development
- Disease stage
- Disease location
- Presence of plus disease
- Need for treatment
Repeated examinations are often necessary because ROP can change over time.
Treatment for ROP
Most infants with ROP do not require treatment and improve naturally.
However, treatment is recommended when disease reaches levels associated with a high risk of vision loss.
Laser Photocoagulation
Laser treatment is one of the most established therapies for ROP.
The laser treats the peripheral retina to reduce abnormal blood vessel growth.
Laser therapy has significantly reduced the risk of retinal detachment and blindness from ROP.
Anti-VEGF Injections
Anti-VEGF medications may be used in selected cases, particularly for aggressive forms of ROP.
These medications help slow abnormal blood vessel growth.
Because retinal development continues after treatment, long-term follow-up is especially important.
Surgery
Advanced ROP with retinal detachment may require surgery, including:
- Scleral buckle surgery
- Vitrectomy surgery
Visual outcomes for advanced stages are often more limited.
What Is the Prognosis?
The outlook depends on the severity of the disease.
Mild ROP
Most infants with mild ROP experience spontaneous improvement without long-term vision problems.
Treated ROP
Many babies who receive timely treatment maintain useful vision.
Advanced ROP
Severe disease with retinal detachment carries a higher risk of permanent vision loss.
Even children whose ROP resolves may have an increased risk of developing:
- Nearsightedness (myopia)
- Strabismus
- Amblyopia ("lazy eye")
- Glaucoma
- Retinal detachment later in life
For this reason, long-term eye examinations remain important.
Living With a History of ROP
Children who had ROP should continue to receive regular eye care throughout childhood and adulthood.
Parents can help by:
- Keeping all follow-up appointments
- Monitoring visual development
- Ensuring children wear prescribed glasses
- Reporting new visual concerns promptly
- Informing future eye care providers about the history of prematurity and ROP
Early intervention services can help optimize development for children with visual impairment.
Frequently Asked Questions
Does every premature baby develop ROP?
No. Many premature infants never develop ROP, and many who do have mild disease that resolves without treatment.
Can ROP be cured?
Many cases improve on their own, and timely treatment can greatly reduce the risk of severe vision loss. However, children with a history of ROP require lifelong eye monitoring because of increased risks of other eye conditions.
Will my child become blind from ROP?
Most children with ROP do not become blind. Early screening and prompt treatment of severe disease have dramatically improved outcomes.
More Information
For additional patient information, visit the American Society of Retina Specialists Retinopathy of Prematurity Page.
References
- American Society of Retina Specialists (ASRS) – Retinopathy of Prematurity
- National Eye Institute – Retinopathy of Prematurity
- American Academy of Ophthalmology – Retinopathy of Prematurity
- EyeWiki – Retinopathy of Prematurity