Retinopathy of Prematurity

ROP develops in the neonatal intensive care unit (NICU) setting and often shows no visible symptoms that a parent can observe at home during its early stages. Because ROP affects the internal structures of the eye, there are typically no outward signs a parent would notice in a newborn. Babies cannot communicate changes in their vision, making professional screening the only reliable way to detect the condition. This is why structured screening programs in NICUs are so important for all qualifying premature infants.

In advanced or untreated cases, parents may notice certain signs as their child grows. These can include a white appearance (leukocoria) in the pupil, or eyes that appear crossed or misaligned, which may also be related to strabismus in children. Abnormal eye movements similar to those seen in nystagmus may also develop. Parents may also notice difficulty tracking objects or poor visual responsiveness.

Even without visible symptoms, any premature infant who meets screening criteria should undergo a dilated eye examination. Catching ROP before it progresses to advanced stages gives your child the best chance at preserving healthy vision.

The standard treatment for severe ROP is laser photocoagulation, which uses targeted laser energy to treat the peripheral avascular retina and stop abnormal blood vessel growth. Anti-VEGF (vascular endothelial growth factor) injections are an increasingly used alternative that can reduce abnormal vessel activity while potentially allowing more normal retinal vascularization to continue. Recent studies suggest anti-VEGF therapy may offer benefits including reduced retinal detachment risk, fewer follow-up surgeries, and lower rates of myopia compared to laser treatment alone. In advanced cases involving retinal detachment, surgical procedures such as vitrectomy or scleral buckling may be needed.

When ROP is detected and treated at the appropriate time, most infants retain functional vision. The Early Treatment for Retinopathy of Prematurity study demonstrated that treating high-risk prethreshold ROP promptly significantly reduces the chance of unfavorable structural and visual outcomes. Early treatment cannot guarantee perfect vision, but it dramatically improves the odds of preserving sight compared to delayed intervention.

ROP is not considered a hereditary condition. It results from the interruption of normal retinal blood vessel development caused by premature birth and the postnatal environment, particularly fluctuations in oxygen exposure. While some research suggests that genetic factors may influence susceptibility, the primary risk factors remain gestational age and birth weight rather than family history.

The outlook depends on severity. Mild ROP (Stages 1 and 2) frequently resolves on its own without any treatment as the retinal blood vessels continue to mature. More advanced disease that receives timely laser or anti-VEGF treatment generally has favorable structural outcomes. Children who have had ROP are at higher risk for developing refractive errors such as nearsightedness, as well as conditions like amblyopia and strabismus, so ongoing eye care throughout childhood is important.

After the acute screening period ends, children with a history of ROP should continue to have regular eye exams throughout childhood. We typically recommend examinations at least every six to twelve months during the first few years, with annual exams afterward unless a specific concern arises. Children with treated ROP or residual retinal changes may require more frequent visits to monitor for late complications such as retinal detachment or progressive refractive changes.

If your child was born prematurely and you have not been contacted about ROP screening, reach out to your neonatologist or pediatrician right away. After discharge from the NICU, any new visual concerns, such as unusual eye movements, a white pupil reflex, or apparent difficulty seeing, should prompt an evaluation. Children born prematurely also benefit from comprehensive eye exams to screen for related conditions, including those that may affect children with genetic and developmental differences.