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Retinopathy of Prematurity

With advances in neonatal care, smaller and more premature infants are thriving. Generally, the more premature the baby and lower the birth weight, the greater the risk for retinopathy of prematurity (ROP), a retinal disorder. ROP is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness.

Children’s National’s Pediatric Ophthalmology Team has years of experience with ROP. Several hundred new patients are seen annually in Children’s National’s neonatal intensive care unit; each infant is seen on average about five times more, prior to being discharged or transferred to another facility. ROP patients are also seen in Children’s National’s main Eye Clinic and our Regional Outpatient Centers. Children’s National’s highly experienced pediatric ophthalmologists provide screening exams, laser treatments, and retinal consultation.

What is retinopathy of prematurity (ROP)?

The retina is the inner lining of the eye that takes in light and turns it into visual messages that are sent to the brain. If you think of the eye as being like a camera, the retina works like the film for the camera.

ROP occurs when abnormal blood vessels grow and spread throughout the retina. Blood vessels that supply the retina are one of the last structures of the eye to mature; these vessels have barely completed growing even when a baby is born at full-term. Sometimes, for reasons not yet fully understood, these blood vessels in the immature part of the retina may develop abnormally, which is ROP. When ROP develops, one of three things can happen:
  1. In most babies who develop ROP, the abnormal blood vessels will heal themselves completely, usually during the first year of life.

  2. In some babies, the abnormal blood vessels heal only partially and these babies commonly develop nearsightedness, “lazy eye”, or a “wandering eye”. Glasses may be required in early life. In some cases, a scar may be left in the retina, resulting in vision problems that may not be entirely correctable with glasses.

  3. In the most severe cases of ROP, the abnormal blood vessels form scar tissues, which pull the retina out of its normal position from the back of the eye. This problem results in a severe loss of vision. Retinal detachment is the main cause of visual impairment and blindness in ROP. There is treatment to minimize severe vision loss. However, despite all treatment given, sometimes vision cannot be preserved and this condition may lead to blindness.
There are five stages of ROP, from mild (Stage I) to severe (Stage V). About 90 percent of all infants with ROP are in the milder stages and do not need treatment. However, infants in more severe stages of the disease can develop impaired vision or even blindness. About 1,100-1,500 infants annually develop ROP that is severe enough to require medical treatment. Each year, about 400-600 infants in the United States become legally blind from ROP.

How is ROP diagnosed?

In Children’s National’s neonatal intensive care unit, the following infants are determined to be at risk for ROP and are routinely screened:
  • Premature infants, born at or before 32 weeks
  • Premature infants weighing less than 3 pounds, 5 ounces (1500 grams)
  • Premature infants, other than those in the first two categories, who are determined to have a complicated neonatal course
The eye examinations, which take less than 15 minutes, takes place every one to two weeks until the retina is fully mature or needs treatment.

The most extreme premature babies are monitored during the examinations to measure heart rate and respirations, as they are very sensitive to any stress.

How is ROP treated?

The Ophthalmology staff at Children’s National has a well-recognized level of expertise in screening and treating this highly complex and vision threatening disease.

The most effective proven treatments for ROP are laser therapy or cryotherapy. Both laser treatments and cryotherapy are performed only on infants with advanced ROP.

In the later stages of ROP, other treatment options include:
  • Scleral Buckle: This involves placing a silicone band around the eye and tightening it. Sclera buckles are usually performed on infants with stage IV or V.
  • Vitrectomy: Vitrectomy involves removing the vitreous and replacing it with a saline solution. Vitrectomy is performed only at stage V.
What is the long-term outlook for a child with ROP?

Premature babies may need glasses early in life. Other problems such as strabismus (misaligned eyes), amblyopia (“lazy eye”), glaucoma, and cataracts can occur. In many cases, these eye problems can be treated or controlled.

If a vision impairment results from ROP, Children’s National’s physicians are well equipped to support the needs of your child and help families understand the multiple needs of children born prematurely. Timely follow-up is key to achieving a good vision outcome. Children’s National’s doctors are highly trained to identify the infants needing laser treatment and provide long-term pediatric ophthalmology care.

Meet the Team

All Children’s National’s ophthalmologists evaluate patients for ROP. Additional staff help coordinate care for children with ROP, including:
  • Ana Carrera, ROP administrative coordinator
  • Elaine S. Jeffress, MSN, APRN, pediatric nurse practitioner

Locations (Outpatient Centers): For appointments: Call 202-476-3015
ROP Coordinator: 202-476-4636 (phone); 202-476-4277 (fax)

Resources for Families

Scholarly articles noted in original draft

Deegan W, Miller MM: Laser for Retinopathy of Prematurity, Chapter 49 In: Atlas of Procedures in Neonatology, MG MacDonald, J Ramasethu (eds), 4th edition, Lipincott Williams and Wilkins, Baltimore, 2007, pages 369-374.

Miller MM, Menacher SJ, Batshaw ML: Vision: Our Window to the World. Updated Chapter. In: Children with Disabilities, ML Batshaw (ed), 6th edition, Brookes, Baltimore, 2007.

Helpful Web sites

American Association for Pediatric Ophthalmology and Strabismus

Association for Retinopathy of Prematurity and Related Diseases

National Eye Institute (NEI)

Retinopathy of Prematurity - Departments & Programs - Children's National Medical Center