What it is
The blood vessels that supply the retina grow outward from the optic nerve during the last months of pregnancy, reaching the far edge of the retina at around the time of a full-term birth. When a baby is born early, that process is interrupted. The peripheral retina is left without a blood supply, and as the baby grows it signals for new vessels. Those new vessels are abnormal — fragile, disorganized, and prone to forming scar tissue that can contract and pull the retina off the back of the eye.
Most retinopathy of prematurity is mild and resolves entirely on its own as the retina finishes vascularizing. A minority progresses, and it is that minority that screening exists to catch.
Which babies are screened
These examinations are performed at the bedside in the NICU. Screening criteria are set by national guidelines and are applied together with the neonatal team. In general, babies born at or below about 30 weeks of gestation, or weighing about 1500 grams or less at birth, are screened — along with larger or later babies whose clinical course puts them at risk, at the neonatologist’s request. The first examination is timed by the baby’s gestational and chronological age, usually at four to six weeks of life.
Screening is repeated on a schedule — commonly every one to three weeks — until the retina is fully vascularized or the risk of progression has passed. Keeping every scheduled examination matters. ROP can advance quickly, and the window in which treatment is most effective is narrow.
What the examination is like
The baby’s eyes are dilated with drops beforehand. A tiny speculum holds the eyelids open, and the retina is examined with an indirect ophthalmoscope, sometimes with a wide-field camera that photographs the retina. The examination takes a few minutes per eye. Babies do not enjoy it, and the nursing team uses sucrose, swaddling, and topical anesthetic drops to keep them comfortable. There is no lasting harm from the exam itself.
Stages and what they mean
ROP is described by three things: the stage (1 through 5, describing how abnormal the vessel growth is, with stage 4 and 5 meaning the retina has begun to detach), the zone (how close to the center of the retina the abnormal area sits — the closer to the center, the more concerning), and the presence of plus disease (dilated, tortuous vessels at the back of the eye, which signals active, aggressive disease).
You may hear these terms used at the bedside. Stage 1 and 2 without plus disease usually just get watched. It is the combination of a posterior zone with plus disease that prompts treatment.
Treatment
- Laser photocoagulation to the avascular peripheral retina remains a standard treatment. It halts the abnormal signal for new vessel growth. It is performed under sedation or anesthesia, and it costs some far peripheral vision in exchange for protecting the central retina.
- Anti-VEGF injection into the eye is now widely used, particularly for disease in the most posterior zone, where it can produce a rapid regression and allow the retina to continue vascularizing normally. Babies treated with injection need especially careful follow-up, because the disease can reactivate weeks later.
- Surgery — scleral buckle or vitrectomy — is reserved for eyes in which the retina has already begun to detach.
We provide both laser and anti-VEGF treatment for ROP. Treatment decisions are made together with the examining ophthalmologist and the neonatology team, and treated babies are re-examined frequently until the disease is confirmed to be regressing.
Our role
ROP care in Central New York is a team effort. At-risk infants are examined in the NICU on the schedule national guidelines require, with our pediatric ophthalmology colleagues at Upstate helping to cover that screening and the neonatology team coordinating care at the bedside.
When a baby needs treatment, we provide it. Our physicians treat ROP with laser photocoagulation or intravitreal anti-VEGF injection in the neonatal intensive care unit at Crouse Hospital, and we stay involved in the follow-up examinations that confirm the disease is regressing.
If your baby has been referred to us for ROP treatment, or you have questions about what was found, call us at (315) 445-8166 — we are glad to explain what happens next.
After the NICU — lifelong follow-up
Even after ROP has resolved, children born prematurely carry a higher lifetime rate of nearsightedness, strabismus (eye misalignment), amblyopia (“lazy eye”), and, much later, retinal tears or detachment. These are all manageable when they are found early.
Every child with a history of ROP should have regular eye examinations through childhood, and should know as an adult that they had ROP. If you are a parent reading this after discharge, ask for a copy of your child’s ROP records for their permanent file — it is information they will be asked for decades from now.