Retinopathy of prematurity (ROP) is a condition that can affect premature babies, potentially leading to vision problems or blindness if left untreated. It occurs when the blood vessels in the eyes don’t develop properly, which is more common in babies born before 31 weeks of gestation. While ROP can be serious, early detection and intervention can help manage the condition effectively. For parents of premature babies, understanding ROP is crucial. written by Inge Loubser, junior partner of the Mellins Full Service Optometry Group explores what retinopathy of prematurity is, the signs to watch for, and how it is treated, ensuring that your baby’s vision health is protected.
With the advent of improved neonatal intensive care techniques, the mortality for medically fragile infants has drastically decreased. For instance, the mortality for children with birth weights of 1000g to 1500g fell from 50% in the 1960s to below 10% in the 1980s.
However, with the improvement of neonatal care, there has also been an increase in the prevalence of various disabilities such as respiratory distress syndrome and bronchopulmonary dysplasia. If either of these has been diagnosed in a baby, one should also suspect the presence of retinopathy of prematurity (ROP).
“Today we are seeing many more infants with ROP than before, and this is likely to continue as neonates of very low birth weight are routinely kept alive,” says Inge Loubser, an optometrist of Mellins i-Style. Infants born to mothers that are substance abusers during their pregnancy are at increased risk of prematurity and therefore more likely to develop ROP.
What is retinopathy?
ROP is a retinal vascular disease and is associated with supplemental oxygenation. As a result, it leads to a reduction in the frequency and degree of supplemental oxygenation given to premature newborns. This decreased the incidence of ROP but led to increased illness and mortality.
Recent studies estimate that up to 40% of infants with birth weights in the range of 1kg to 1.5kg and up to 50-80% of newborns that weigh less than one kilogram may develop some degree of ROP. However, only a small percentage of these infants will experience significant vision loss.
“The onset of ROP is likely to begin 32 to 42 weeks from the time of conception.”
The cause of ROP is thought to be due to the effects of high oxygen levels affecting immature retinal vascular tissue. The retina is the light-sensitive layer of tissue that lines the back of your eye. There is an initial vasoconstriction (constriction of blood vessels) of retinal vessels caused by increased oxygen levels in the blood due to supplemental oxygenation.
This constriction leads to obstruction of the vessels if the arterial oxygen levels remain high enough. When this eventually returns to a more normal oxygen level, there is a rapid increase of vascular endothelium (the cells that line the inside of our blood vessels). This leads to new blood vessels forming and the typical clinical appearance of ROP.
The degree of prematurity and the size of the newborn are probably more important factors in the cause and effect of ROP than is the level of supplemental oxygenation. We can, however, expect to see more ROP in the future as these tiny infants are kept alive.
Diagnosing ROP
It is often difficult to perform an adequate examination on a tiny, crying infant. Eye drops are used to dilate the newborn’s pupil (the ‘window’ into the eye) and an indirect ophthalmoscope, which has a special lens that sends a bright light into the eye, is used to enable the doctor to examine the fundus (the interior lining of the eyeball).
The onset of ROP is likely to begin 32 to 42 weeks from the time of conception and should, therefore, be examined shortly after this time by a paediatric ophthalmologist. It is necessary to monitor infants at risk of ROP for six months or longer after birth.
Infants who have ROP tend to be moderately to severely near-sighted and have a high incidence of amblyopia (lazy eye or impaired vision without an obvious defect), strabismus (abnormal alignment of the eye), cataracts (lens in the eye that becomes opaque), glaucoma (high eye pressure), nystagmus (rapid involuntary movements of the eye) and corneal problems.
Vitamin E therapy was suggested as a means of preventing the risk for the development of ROP based on the ability of vitamin E to neutralise oxygen free radicals that may cause cell damage to the developing retinal blood vessels. Premature infants typically have reduced levels of vitamin E, but there are significant risks of toxicity to vitamin E in premature infants, so this issue has not yet been concluded.
A promising treatment for ROP is cryotherapy where extreme cold is used during surgery to destroy the peripheral areas of the retina. This slows or reverses the abnormal growth of blood vessels. Unfortunately, this treatment can also destroy some side vision.
For more eye care tips and advice, visit www.mellins.co.za
FAQs: What is Retinopathy of Prematurity (ROP) and How is it Treated?
What is retinopathy of prematurity (ROP)?
Retinopathy of prematurity (ROP) is a potentially blinding eye condition that affects premature babies. It occurs when the blood vessels in the retina (the light-sensitive layer at the back of the eye) develop abnormally after birth.
Who is at risk of developing ROP?
ROP typically affects babies born before 31 weeks of gestation or weighing under 1.5kg at birth. The more premature or underweight the baby, the greater the risk.
What causes ROP?
In premature babies, the retina may not be fully developed at birth. After birth, exposure to high oxygen levels, rapid changes in oxygen or unstable medical conditions can trigger abnormal blood vessel growth, which can lead to scarring or retinal detachment.
Is ROP common in South Africa?
Yes. ROP is a growing concern in South Africa, particularly in neonatal intensive care units (NICUs) where more premature babies are surviving but not always being screened early or consistently.
How is ROP detected?
ROP is detected through regular eye screening by an ophthalmologist or trained eye specialist. Screening usually starts between 4 and 6 weeks after birth, depending on the baby’s gestational age and birth weight.
Does ROP always lead to blindness?
No. Most cases of ROP are mild and resolve on their own without treatment. However, if left untreated in severe cases, it can lead to permanent vision loss or blindness.
How is ROP treated?
If treatment is needed, options may include:
- Laser therapy to stop abnormal blood vessel growth
- Anti-VEGF injections (medicine injected into the eye to reduce vessel growth)
- Surgery, in rare advanced cases, to reattach the retina
Early treatment greatly improves the chances of preserving vision.
Is the treatment painful for the baby?
Babies receive pain relief or sedation during treatment to ensure they are comfortable. The procedure is carried out by a specialist in a controlled environment, such as a hospital.
What are the long-term effects of ROP?
Some children may have normal vision, while others may develop short-sightedness, lazy eye (amblyopia), or strabismus (squint). Ongoing eye check-ups are important during early childhood.
Can ROP be prevented?
ROP cannot always be prevented, but the risk can be reduced by:
- Careful monitoring of oxygen levels in premature babies
- Ensuring timely screening and follow-up
- Providing good neonatal care in NICUs
What should I do if my baby has ROP?
Follow your doctor’s guidance, attend all scheduled eye exams and keep track of your baby’s progress. Early intervention is critical to managing the condition effectively.
Disclaimer: This information is for general awareness and does not replace professional medical advice. If your baby is premature or has been diagnosed with ROP, always follow the care plan provided by your neonatologist or eye specialist.
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