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Retinopathy of Prematurity by Alexandra Howson, PhD

Definition

The retina is a light-sensitive layer of tissue. This tissue lines the back of the eye. The retina converts visual images into nerve impulses in the brain that allow sight. Retinopathy of prematurity (ROP) is a rare condition that occurs in the eyes of infants who:

Are born prematurely
Are born with a low birth weight

With this condition, the blood vessels of the retina grow abnormally. This can lead to bleeding and scarring in the retina. In the most serious cases, this can lead to the retina separating from the back of the eye. ROP usually heals by itself. Most infants do not require treatment. In a small number of cases, ROP may cause vision loss or blindness.

Normal Anatomy of the Eye

Causes

ROP occurs most often in infants who are born prematurely or have low birth weight. The exact cause is unknown.

Risk Factors

These factors increase the chance of an infant developing ROP:

Premature birth , especially babies born less than 30 weeks gestation
Low birth weight, especially babies weighing less than three pounds
Hyperoxia (oxygen toxicity)
Respiratory distress
Anemia

Symptoms

ROP usually occurs suddenly. It progresses in stages from mild to severe. There are usually no outward signs of ROP. If your infant has any of these symptoms, do not assume it is due to ROP. These symptoms may be caused by other conditions. Tell your doctor if your infant has any of these:

White pupils
Abnormal eye movements
Crossed eyes (turning toward each other)
Amblyopia (lazy eye)

Diagnosis

Guidelines vary, but a pediatric ophthalmologist (doctor who specializes in eye conditions and treatment in children) will screen for ROP if your infant:

Is born prematurely
Has a low birth weight

The doctor may examine your infant’s eyes every 1-2 weeks until the blood vessels in the retina are fully developed. Eye drops are used to dilate the pupils. The doctor uses a special lens to examine the eye.

Treatment

Talk with the doctor about the best treatment plan for your infant. Treatment options to reduce the risk of your infant’s retina detaching from the back of the eye include the following:

Cryosurgery—a freezing probe is used to prevent the spread of abnormal blood vessels in the retina
Laser ablation/photocoagulation—a laser is used to stop abnormal blood vessels in the retina from growing

Prevention

The best way to prevent ROP is to prevent premature birth. Screening is very important for:

Premature infants
Low birth weight infants

If your infant needs oxygen therapy, the doctor will monitor the oxygen levels to make sure she is getting the right amount.

RESOURCES:

American Academy of Pediatrics http://www.aap.org/
National Eye Institute http://www.nei.nih.gov/

CANADIAN RESOURCES:

Canadian Ophthalmology Society http://www.eyesite.ca/
Canadian Pediatric Society http://www.cps.ca/

References:

Alan R. Detached retina. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 30, 2009. Accessed April 15, 2010.
American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics . 2006;117(2):572.
DynaMed Editorial Team. Retinopathy of prematurity. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 5, 2010. Accessed April 26, 2010.
Harrell SN, Brandon DH. Retinopathy of prematurity: the disease process, classifications, screening, treatment, and outcomes. Neonatal Netw . 2007;26(6):371-378.
Lewis R. Retinopathy of prematurity. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/default.php?id=3 . Published November 11, 2008. Updated date. Accessed April 15, 2010.
March of Dimes. Low birthweight. March of Dimes website. Available at: http://www.marchofdimes.com/professionals/14332_1153.asp . Updated May 2008. Accessed April 22, 2010.
National Eye Institute. Retinopathy of prematurity. National Eye Institute website, Available at: http://www.nei.nih.gov/health/rop . Updated February 2010. Accessed April 26, 2010.
Neff D. Discharge instructions for premature birth. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15;topicID=81 . Updated December 2009. Accessed April 22, 2010.
Olitsky SE, Hug D, Smith LP. Retinopathy of prematurity. In: Kleigman RM, Behrman RE, Jenson HB, Stanton BF. Nelson’s Textbook of Pediatrics . 18th ed. St. Louis, MO: Saunders. 2007.

Last reviewed June 2012 by Kari Kassir, MD

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