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Retinopathy of Prematurity (ROP)

By Arthur E. Kopelman, MD, The Brody School of Medicine at East Carolina University

Retinopathy of prematurity is a disorder in which the small blood vessels in the back of the eye (retina) grow abnormally.

  • Retinopathy of prematurity is strongly associated with premature birth, with most cases occurring in infants who are born after 26 or fewer weeks of pregnancy.

  • In the most severe cases, the rapid abnormal growth of the small blood vessels makes them bleed, leading to scarring of the retina and vision loss.

  • Because affected newborns have no symptoms, diagnosis depends on a careful examination by an eye specialist (ophthalmologist).

  • This disorder is usually mild and resolves without treatment, but the eyes need to be monitored by an ophthalmologist until blood vessel growth is mature.

  • If the disorder is severe, newborns require laser treatment to prevent vision loss.

In infants who were born very prematurely, growth of the blood vessels supplying the retina may stop growing for a time. When growth resumes, it occurs in a disorganized fashion. During disorganized rapid growth, the small blood vessels may bleed, which eventually leads to scarring. In the most severe cases, this process may ultimately result in detachment of the retina from the back of the eye and loss of vision.

Newborns who are developing retinopathy of prematurity do not have symptoms, and diagnosis depends on careful examination of the back of the eyes by an ophthalmologist. Routinely, therefore, an ophthalmologist examines the eyes of premature newborns who weigh less than 3 pounds (about 1,500 grams) at birth starting about 4 weeks after delivery. Eye examinations are repeated every 1 to 2 weeks as needed, until growth of the blood vessels in the retina is complete. Newborns with severe retinopathy must have eye examinations, at least yearly, for the rest of their life. If detected early, retinal detachment can be treated to attempt to avoid loss of vision in the affected eye.

Prevention and Treatment

In premature newborns who need oxygen, oxygen levels are monitored carefully so that the lowest amount of oxygen necessary can be used. Oxygen levels can be indirectly monitored using a pulse oximeter (an external sensor that measures the level of oxygen in the blood going through a finger or toe).

Retinopathy is usually mild and resolves spontaneously.

For very severe retinopathy of prematurity, laser treatment is done on the outermost portions of the retina. This treatment stops the abnormal growth of blood vessels and decreases the risk of retinal detachment and loss of vision.

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