Retinopathy of Prematurity (ROP): Causes, Symptoms & Risk Factors

Retinopathy of Prematurity (ROP) is an eye condition that affects some infants born prematurely, especially those born before 31 weeks. In ROP, abnormal blood vessels form in the baby’s retina.

The retina is the layer of tissue at the back of the eye that converts light into electrical signals, which travel to the brain. The brain processes these signals and creates the images we see.

In most cases, the abnormal blood vessels in ROP don’t cause harm and don’t need special treatment other than regular monitoring. Up to 90% of babies with ROP improve without treatment and develop normal vision. However, in some cases, the condition can worsen and threaten the baby’s vision.

In these situations, timely treatment is needed to prevent permanent damage to the retina and vision loss. Without proper treatment, advanced ROP can lead to blindness.

Healthcare providers recommend screenings for at-risk babies to detect ROP early and identify when treatment is needed. Following the screening schedule is crucial to reduce the risk of vision problems.

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Causes of Retinopathy of Prematurity

The exact cause of ROP is multifactorial, involving genetic and environmental factors. However, the primary risk factor is prematurity, with smaller, more premature infants at higher risk. Other contributing factors include:

High Oxygen Therapy: Excessive oxygen levels can disrupt normal retinal vascular development.
Low Birth Weight: Infants weighing less than 1500 grams are particularly susceptible.
Infections and Inflammation: Neonatal sepsis and other diseases can exacerbate the condition.
Genetic Predisposition: Family history may play a role in the development of ROP.

Symptoms of Retinopathy of Prematurity

ROP often doesn't show any visible symptoms in the early stages, so regular eye screenings are very important for premature babies. As the condition progresses, signs may include:

Poor eye tracking or movement
White pupils (leukocoria)
Abnormal eye movements or misalignment

Diagnosis and Screening

Routine screening is the most effective way to diagnose ROP early, especially in babies born prematurely. An eye specialist (ophthalmologist) uses specialized equipment to examine the retina and monitor blood vessel development. Early detection is vital, as it allows for timely intervention to prevent vision loss.

Stages of Retinopathy of Prematurity (ROP)

ROP is classified into five stages based on the severity of the disease and the progression of abnormal blood vessel growth. These stages help doctors determine the appropriate course of action for treatment:

Stage 1: Mild ROP - The blood vessels in the retina have abnormal growth, but the disease is not yet threatening vision. This stage often resolves on its own without treatment.
Stage 2: Moderate ROP - Abnormal blood vessel growth continues, and the condition may require close monitoring. In many cases, no intervention is needed, but regular check-ups are essential.
Stage 3: Severe ROP - At this stage, abnormal blood vessels grow and can cause the retina to become detached. Treatment may be necessary to prevent vision loss.
Stage 4: Advanced ROP - The retina becomes partially detached, and there is a significant risk of vision impairment. Surgical intervention is usually required to reattach the retina.
Stage 5: End-stage ROP - Complete retinal detachment occurs, often resulting in permanent blindness. Surgery may still be attempted, but the chances of restoring vision are minimal.

Treatment Options

The depth of retinal damage and the severity of ROP determine the course of treatment. Typical approaches to treatment include:

Laser therapy: In severe cases of ROP, laser treatment may be used to stop the abnormal blood vessels from growing.
Cryotherapy: Cold treatment may be used to reduce abnormal blood vessels.
Surgical intervention: In advanced cases, surgery may be required to detach the retina or correct other vision problems.
Anti-VEGF medication: In certain situations, medications that block the growth of abnormal blood vessels may be prescribed.

Preventing Retinopathy of Prematurity

While ROP cannot always be prevented, ensuring premature infants receive the appropriate care can reduce the risk.

Monitoring oxygen levels in premature babies to prevent excessive oxygen exposure.
Providing proper neonatal care to reduce the risk of infections and other complications.

Risk factors for Retinopathy of Prematurity (ROP) include:

Premature birth (born before 31 weeks of gestation)
Low birth weight (under 1500 grams or 3.3 lbs)
Exposure to high levels of oxygen (during neonatal care)
Infections or illness during pregnancy or after birth
Multiple pregnancies (twins, triplets, etc.)
Poor neonatal care or complications during delivery
Unstable medical conditions in the newborn (e.g., respiratory issues or heart problems)
Family history of ROP (although it's rare, some genetic factors may contribute)

Conclusion

Retinopathy of Prematurity is a serious condition that needs early detection and treatment to prevent blindness or long-term vision problems. Regular eye screening, timely treatment, and proper care are key to managing this condition and safeguarding the vision of premature babies.

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Long-term Outcomes and Follow-up

The long-term outcomes for babies with ROP vary based on the severity of the condition and how effective the treatment is. While many babies recover with minimal vision loss, some may face complications such as:

Myopia (Nearsightedness)
Strabismus (Crossed Eyes)
Amblyopia (Lazy Eye)
Glaucoma
Retinal Detachment

Regular follow-up with an ophthalmologist is crucial to monitor complications and ensure timely treatment if needed.

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Frequently Asked Questions

Yes, early detection of ROP is crucial for effective treatment. In mild cases, it may resolve without treatment. For more severe cases, treatments like laser therapy, cryotherapy, or anti-VEGF medications can help prevent vision loss.

Premature babies, especially those born before 31 weeks or weighing less than 1500 grams, should be screened for ROP starting at around 4 to 6 weeks after birth. The frequency of screening may vary depending on the baby’s condition and risk factors.

ROP is very rare in full-term babies. It primarily affects premature infants born before 31 weeks of gestation. Full-term babies usually have fully developed retinas, reducing the likelihood of developing this condition.

Yes, ROP can develop in both eyes of a premature infant. While it may affect one eye more than the other, it is common for both eyes to be involved, and both should be monitored regularly.

Doctors monitor the progress of ROP by conducting regular eye exams, typically every 1–2 weeks, to track changes in the blood vessels. The ophthalmologist will also use imaging tests like retinal photography to assess the condition and adjust treatment plans as needed.