Retinopathy of Prematurity (ROP) is an eye condition predominantly found in premature infants, especially those with a birth weight below 1,500 grams. This condition primarily affects the retinal blood vessels, leading to neovascularization or scarring.

Known as proliferative vitreoretinopathy in clinical terms, ROP often resolves spontaneously. However, in severe cases, it can escalate rapidly, resulting in retinal detachment and irreversible blindness. Early detection is crucial to prevent the loss of normal vision in affected children.

Key Risk Factors for ROP

The primary risk factor for ROP is an underdeveloped retina, commonly seen in babies born before 32 weeks of gestation or weighing less than 1,500 grams. Additional risk factors exacerbating ROP include:

  • Extended medical treatments like prolonged endotracheal intubation, lengthy oxygen supplementation, and blood transfusions.
  • A history of multiple pregnancies, respiratory distress syndrome (RDS), or complications during pregnancy.
  • Neonatal conditions such as intracerebral hemorrhage, seizures, anemia, or congenital heart defects.
  • Maternal health issues during pregnancy, including diabetes and hypertension.

Stages of Retinopathy of Prematurity

ROP progresses through five stages, ranging from mild to severe:

  1. Stage I: Incomplete vascularization with a clear demarcation line.
  2. Stage II: Ridge formation at the demarcation line, halting normal vascular growth.
  3. Stage III: Erratic blood vessel growth within the ridge towards the eye's center, accompanied by scar tissue formation.
  4. Stage IV: Retinal partial detachment due to scar tissue tension.
  5. Stage V: Complete detachment of the retina.

When Should I Consult an Ophthalmologist?

Infants at high risk should undergo their initial retinal examination 4-6 weeks post-birth, with subsequent checks every 1-4 weeks based on the initial assessment results. These examinations continue until the retinal blood vessels are fully matured. Mydriatic drugs are used cautiously for pupil dilation during these comprehensive retinal exams. Parents should be aware of potential side effects like increased heart rate and breathing irregularities.

Treatment Options for ROP

Treatment typically commences within 72 hours of diagnosing stage III or higher ROP. Treatment approaches, tailored to the severity and at the discretion of the attending physician, include:

  • Cryosurgery.
  • Laser photocoagulation.
  • Anti-vascular endothelial growth factor (anti-VEGF) injections to inhibit abnormal blood vessel growth.
  • Vitrectomy and retinal surgery in more aggressive cases to address retinal detachment.

Post-Treatment Patient Care

Post-treatment monitoring is critical, even if ROP is not severe, as complications can arise. These include vision issues like short- or long-sightedness, astigmatism, strabismus (eye misalignment), lazy eye, early-onset cataract or glaucoma, and potential retinal detachment. Regular eye examinations are essential for a complete recovery from ROP and to prevent any possible complications.

Preventing Retinopathy of Prematurity

Preventive measures for ROP start before pregnancy. Prospective mothers should undergo a health check to ensure they are in optimal health. To reduce the risk of premature birth and low birth weight, mothers should:

  • Follow National Health Recommendations for self-care.
  • Receive vaccinations as advised by their doctor to avoid preventable infectious diseases during pregnancy.
  • Engage in early antenatal care upon confirming pregnancy and adhere to obstetrician-guided care through delivery.