Retinopathy of Prematurity
Abnormal retinal blood vessel growth affecting premature infants
Quick Facts
- Type: Eye (retinal) disorder of infancy
- Who it affects: Premature, low-birth-weight babies
- Main risk factors: Early birth, low birth weight, oxygen therapy
- Detection: Dilated eye screening exams
Overview
Retinopathy of prematurity (ROP) is an eye condition that can develop in babies born prematurely. The retina is the light-sensitive layer at the back of the eye, and its blood vessels normally finish growing only in the final weeks of pregnancy. When a baby is born early, this growth can be interrupted and then resume in a disorganized way, producing fragile, abnormal vessels.
In most infants, ROP is mild and resolves on its own without affecting sight. In a smaller number, the abnormal vessels scar and pull on the retina, which in the most severe cases can lead to retinal detachment and serious vision loss. Because early ROP causes no outward signs, routine eye screening of at-risk babies is essential.
Symptoms
ROP in its early stages produces no visible signs and cannot be detected by simply looking at the baby. It is found only through a specialized eye examination. Signs of advanced disease, when present, may include:
- Abnormal eye movements (nystagmus)
- Eyes that appear misaligned (crossed or wandering)
- A white appearance in the pupil (leukocoria) in severe, late cases
- Poor visual responses as the baby grows
Because these signs appear only after significant damage, parents should never wait for symptoms. Screening exams catch ROP long before any outward change is visible.
Causes
ROP results from incomplete and then abnormal development of the retinal blood vessels after premature birth. Before birth, the womb is a low-oxygen environment, and retinal vessels grow steadily toward the edges of the retina. Premature birth exposes the developing retina to a relatively high-oxygen environment, which can pause normal vessel growth.
Later, the under-supplied retina releases growth signals that trigger a rebound of rapid, disorganized vessel growth. These new vessels are leaky and fragile, and the scar tissue that can form around them may contract and tug on the retina.
Risk Factors
- Birth well before the due date (the earlier the birth, the higher the risk)
- Very low birth weight
- Prolonged supplemental oxygen therapy
- Other illnesses of prematurity, such as breathing problems and infections
- Slow weight gain after birth
Diagnosis
ROP is diagnosed through a dilated retinal examination performed by an eye specialist, typically beginning a few weeks after birth for babies who meet screening criteria (based on gestational age and birth weight). Eye drops widen the pupils, and the doctor examines the retina to check how far the vessels have grown and whether abnormal vessels are present.
Findings are described by zone (how far vessels have reached) and stage (severity, from mild stage 1 to retinal detachment in stage 5). The presence of "plus disease" (dilated, twisted vessels) signals more aggressive disease. Repeat exams continue until the retina has fully matured or treatment is complete.
Treatment
Most cases of ROP are mild and need only careful monitoring, as the abnormal vessels often regress on their own. When the disease reaches a treatment threshold, options include:
- Laser therapy: Laser is applied to the outer retina to stop abnormal vessel growth and reduce the risk of detachment. This is a long-established treatment.
- Anti-VEGF injections: Medicine injected into the eye blocks the growth signal driving abnormal vessels and may be used alone or with laser.
- Surgery: For advanced disease with retinal detachment, procedures such as scleral buckling or vitrectomy may be attempted to reattach the retina.
Even after successful treatment, children who had significant ROP need long-term eye follow-up because they remain at higher risk of nearsightedness, lazy eye, and other vision problems.
Prevention
- Good prenatal care to reduce the chance of premature birth
- Careful, monitored use of supplemental oxygen in premature babies
- Following recommended ROP screening schedules for all at-risk infants
- Prompt treatment when disease reaches the threshold, which greatly improves outcomes
When to See a Doctor
If your baby was born prematurely or with low birth weight, ask the neonatal team whether ROP screening is needed and make sure all scheduled eye exams are completed. After discharge, contact your child's doctor or eye specialist if you notice:
- Eyes that wander, cross, or do not move together
- A white or cloudy appearance in the pupil
- Poor visual tracking or lack of response to faces and objects
- Any concern about how your child is seeing
Frequently Asked Questions
Will my premature baby definitely get ROP?
No. Many premature babies never develop ROP, and most who do have mild disease that resolves on its own. Risk is highest in the smallest and earliest-born infants, which is why screening is targeted to those babies.
When does ROP screening start?
Screening usually begins a few weeks after birth, timed by gestational age and birth weight, and exams are repeated on a schedule until the retina matures. Your baby's neonatal and eye care team will set the exact timing.
Can ROP be treated successfully?
Yes. When ROP reaches the treatment threshold, laser therapy or anti-VEGF injections are effective at stopping abnormal vessel growth and reducing the risk of retinal detachment, especially when started promptly.
Does ROP always cause blindness?
No. Most children with ROP keep good vision. Blindness is uncommon and is largely limited to the most severe, untreated cases that progress to retinal detachment, which is why timely screening matters.
Will my child need glasses or follow-up?
Children who had meaningful ROP are more likely to need glasses and to have lazy eye, crossed eyes, or other issues. Long-term eye check-ups help detect and manage these early.
References
- National Eye Institute (NEI). Retinopathy of Prematurity.
- American Academy of Ophthalmology. Retinopathy of Prematurity.
- MedlinePlus, U.S. National Library of Medicine. Retinopathy of prematurity.
- Centers for Disease Control and Prevention (CDC). Vision Health Initiative.