Retinopathy of Prematurity(ROP)

Evidence 

https://www.sciencedirect.com/topics/social-sciences/retinopathy-of-prematurity

Das, J. Byrd

ROP is characterized by abnormal vasculogenesis with retinal neovascularization in the periphery. The incidence of ROP is about 68% in infants born below 1250 g, and this rate goes higher to 93% in infants born below 750 g. Not all premature infants develop ROP. Most newborns with ROP show clinical lesions around 32 weeks' postmenstrual age. About 10% of ROP babies eventually need treatment.

Education

Retinopathy of Prematurity (ROP) is an eye disorder that primarily affects premature infants where the risk significantly increases with babies weighing under 1250 grams and/or less that are born before 31 weeks of gestation. The smaller a baby is at birth, the more likely that baby is to develop ROP.

ROP occurs when abnormal blood vessels grow and spread throughout part of the retina starving for oxygen, the tissue that lines the back of the eye. These abnormal blood vessels are fragile and can leak, scarring the retina and pulling it out of position. This causes a retinal detachment. Retinal detachment is the main cause of visual impairment and blindness in ROP.

Scientists believe that the periphery of the retina then sends out signals to other areas of the retina for nourishment. As a result, new abnormal vessels begin to grow. These new blood vessels are fragile and weak and can bleed, leading to retinal scarring. When these scars shrink, they pull on the retina, causing it to detach from the back of the eye.

ROP is classified in five stages, ranging from mild (stage I) to severe (stage V):

• Stage I — Mildly abnormal blood vessel growth
• Stage II — Moderately abnormal blood vessel growth
• Stage III — Severely abnormal blood vessel growth
• Stage IV — Partially detached retina
• Stage V — Completely detached retina and the end stage of the disease

How is ROP diagnosed?

All babies weighing less than 1250 grams at birth will have regular eye examinations after their gestational age reaches 30 to 31 weeks. These examinations are undertaken by a medical eye specialist known as an ophthalmologist. To look at the back of a baby's eyes the pupil (black circle in the middle of the coloured part at the front of the eye) needs to be dilated (see figure 2). Eye drops are used to dilate the pupils. The examination only takes a couple of minutes. Your baby may be minimally upset by these examinations and will settle very quickly once the eyes have been checked.

ROP Treatment:

A retina specialist who examines a baby with ROP will know when to watch the condition and when to treat it, based on guidelines. Treatment may include:

• Cryotherapy (freezing) or photocoagulation (laser therapy) to stop the growth of blood vessels and keep the retina attached to the back of their eye.
• Scleral buckling, where the doctor places a band around your child’s eye. This pushes it inward, which helps keep the retina in place against the walls of the eye. The band will be removed in a few months or years.
• Vitrectomy, a more involved surgery. The doctor replaces the vitreous fluid inside your child’s eye with a saline solution. Then they remove any scar tissue from inside the eye. This allows the retina to relax in place against the eye wall.
• Medications placed inside the eye. Studies are ongoing to see if the medications that treat adult age-related macular degeneration can be used.

Early treatment can help preserve central vision, which lets your child see straight ahead, read, see colours, and drive. Some of these procedures can lead to a loss of side vision.

Complications

Infants with ROP are considered to be at higher risk for developing certain eye problems later in life, such as:

• Myopia (near-sightedness)
• Strabismus (misalignment of the eyes)
• Amblyopia (lazy eye)
• Glaucoma
• Retinal detachment

Your child will need regular eye exams by a specialist as often as they recommend. If the doctor catches them early on, they can treat most of these conditions without any vision loss.

Empowerment

Attending follow up eye exams can be a stressful time because it can remind you of the time when this diagnosis was given in the NICU. This a normal reaction and it is important to know that it is completely ok to allow yourself to approach this appointment for your child when you are feeling good and able to be your child’s best advocate. It is also important to find the right person to do these exams in a relaxed fashion who can give you clear information and clear follow-up guidelines and referrals to other healthcare providers that fit your child’s needs. If you feel that your child needs further investigation the health care provider should be listening to your concerns. Writing out questions ahead of time is helpful if you have noticed problems in your child’s vision. Most of all you should feel that your history of the premature birth should be taken seriously, and they should help you feel comfortable during this time.

Useful Links

The Royal Children's Hospital Melbourne

https://www.rch.org.au/ophthal/patient_information/what_is_rop/

The National Eye Institute

https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinopathy-prematurity

Miracle Babies Foundation

https://www.miraclebabies.org.au/content/retinopathy-of-prematurity-rop/gk6cag

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