ROP

What is ROP?

ROP stands for retinopathy of prematurity. It is an eye condition that affects some babies who are born too early. The retina is the thin layer of light-sensing tissue at the back of the eye that sends images to the brain. In a baby who is born prematurely, the blood vessels that supply the retina have not finished growing. In ROP, these vessels may grow abnormally, which can lead to scarring, bleeding, and, in severe cases, retinal detachment (the retina pulling away from the back of the eye).

ROP mainly affects babies born before about 31 weeks of pregnancy or with a very low birth weight. Full-term babies are not affected, because their retinal blood vessels are normally complete at birth. Many babies with mild ROP get better on their own without any treatment. A smaller number develop more advanced disease that needs treatment to protect their vision.

Understanding what is ROP can feel overwhelming for parents of a premature baby, especially while the child is still in a neonatal intensive care unit (NICU). This page explains the condition in plain language, including rop symptoms, rop causes, rop diagnosis, and the rop treatment options that doctors commonly use.

Symptoms of ROP

One of the most important things to know about rop symptoms is that there are usually none that a parent can see, especially in the early stages. The changes happen deep inside the eye and can only be detected by an eye doctor during a specialized examination. This is why screening (regular planned eye checks) is so important for premature babies.

In more advanced or untreated ROP, or later in childhood, signs may include:

• Abnormal eye movements, such as the eyes drifting or jerking
• Crossed eyes or eyes that do not line up (strabismus)
• A white-looking pupil (leukocoria), which can indicate retinal detachment
• Not following faces, lights, or objects with the eyes at the expected age
• Severe nearsightedness (myopia), meaning distant objects look blurry
• Reduced vision or poor vision in one eye
• Sensitivity to light

Doctors describe ROP by stage, from stage 1 (mild) to stage 5 (severe). They also record the zone, which describes how close the abnormal vessel growth is to the center of the retina, and whether "plus disease" is present. Plus disease means the blood vessels are enlarged and twisted, which signals that the condition is more active and more likely to progress.

• Stages 1 and 2: Mild changes at the edge of the growing blood vessels. These stages often improve on their own and cause no symptoms.
• Stage 3: Abnormal new blood vessels grow toward the center of the eye. Treatment may be considered, especially if plus disease is present.
• Stage 4: Partial retinal detachment. Vision may be affected.
• Stage 5: Complete retinal detachment, which can cause severe vision loss or blindness.

Because the baby cannot describe what they see, the stage is determined entirely by examination rather than by symptoms.

Causes and risk factors

The main cause of ROP is being born early. During a normal pregnancy, the blood vessels of the retina grow gradually from the center outward and are usually complete near the time of full-term birth. When a baby is born prematurely, this growth is interrupted. Outside the womb, the retina is exposed to different oxygen levels and other conditions, and the vessels may stop growing normally and then restart in an abnormal way.

Doctors and researchers continue to study the exact rop causes, but the following factors are widely recognized:

• Prematurity: The earlier the birth, the higher the risk.
• Low birth weight: Babies with very low birth weight are at greater risk.
• Oxygen therapy: Many premature babies need extra oxygen to survive. Large or rapid changes in oxygen levels may contribute to abnormal vessel growth. Neonatal teams carefully monitor oxygen to reduce this risk while still providing what the baby needs.
• Other medical problems of prematurity: Breathing difficulties, infections, anemia (low red blood cells), blood transfusions, and slow weight gain have all been associated with a higher risk.

It is important for parents to understand that ROP is not caused by anything they did or did not do during pregnancy. It is a consequence of the retina not having enough time to finish developing before birth.

Diagnosis

Rop diagnosis is made through a screening eye examination, not through symptoms. Because the condition cannot be seen from the outside, hospitals follow screening guidelines that identify which premature babies should be examined and when.

In general, babies born before a certain gestational age (often around 30 or 31 weeks) or below a certain birth weight are screened. Babies who are slightly larger or older but who had a complicated course in the NICU may also be included. The first examination is usually scheduled several weeks after birth, at a time when ROP typically starts to become visible.

The examination is performed by an ophthalmologist (a medical doctor specializing in eye care), often one with experience in pediatric retinal disease. It usually involves:

• Dilating eye drops: Drops are placed in the baby’s eyes to widen the pupils so the doctor can see the retina clearly.
• Indirect ophthalmoscopy: The doctor wears a headlamp and uses a handheld lens to look at the whole retina. A small instrument may be used to gently hold the eyelids open and to move the eye so the edges of the retina can be seen.
• Digital retinal imaging: In some hospitals, a special camera photographs the retina. These images may be reviewed by a specialist on site or sent for remote review.

The examination is brief but can be uncomfortable for the baby. Nurses often use comfort measures such as swaddling or a sugar solution, and numbing drops may be used. The baby is monitored during and after the exam.

After each examination, the doctor records the stage, zone, and presence or absence of plus disease. Based on these findings, follow-up exams are scheduled, sometimes every one to three weeks, until the retinal vessels have finished growing or the ROP has clearly gone away. If the disease reaches a level where treatment is recommended, this is usually explained to parents promptly, because timing matters.

Follow-up is a key part of rop diagnosis. Missing a scheduled exam can allow the disease to progress unnoticed, so the schedule set by the eye doctor should be followed closely, even after the baby goes home.

Treatment options for ROP

Rop treatment options depend on the stage and location of the disease and on how quickly it is changing. Not every baby with ROP needs treatment.

Observation. For mild ROP (typically stages 1 and 2 without plus disease), the usual approach is careful monitoring with repeat eye examinations. In many cases the abnormal changes stop and the vessels continue to grow normally. This is often called regression.

Laser therapy. When ROP reaches a level that threatens vision, laser treatment is a common option. The laser is applied to the outer parts of the retina that do not yet have blood vessels. This reduces the signals that drive the abnormal vessel growth and helps stop the disease from progressing. The treatment is usually done under sedation or anesthesia in the NICU or an operating room. Laser therapy destroys some peripheral (side) retina, which can slightly narrow the field of vision, but it protects the central vision needed for reading and recognizing faces.

Anti-VEGF injections. VEGF (vascular endothelial growth factor) is a protein that encourages blood vessel growth. Medications that block VEGF can be injected into the eye in a very small dose to slow abnormal vessel growth. This may be used instead of, or in addition to, laser, especially when the disease is located near the center of the retina. Babies who receive these injections need longer follow-up, because the disease can return after the medication wears off, and doctors continue to study the long-term effects of this treatment in infants.

Surgery. If the retina has started to detach (stages 4 and 5), surgery may be recommended. Options include a scleral buckle, in which a soft band is placed around the outside of the eye to push the wall of the eye toward the retina, and vitrectomy, in which the gel inside the eye and scar tissue are removed so the retina can settle back into place. These are complex procedures, and the goal is usually to preserve as much vision as possible rather than to restore normal sight.

Ongoing eye care. Children who have had ROP, whether or not they were treated, are at higher risk of nearsightedness, strabismus, amblyopia (a "lazy eye" in which one eye develops weaker vision), and glaucoma (raised pressure in the eye) later in life. Regular eye examinations through childhood allow these problems to be found and managed with glasses, patching, or other treatments. In many hospital groups, including Acibadem, this long-term follow-up is coordinated through the ophthalmology department together with neonatal and pediatric teams.

Living with ROP and outlook

The outlook for a baby with ROP varies widely. Most babies with mild disease recover without lasting effects, and their vision develops normally or with only minor correction such as glasses. For babies with more advanced disease, timely treatment often prevents severe vision loss, although some reduction in vision or visual field may remain. When retinal detachment occurs, the risk of significant visual impairment is higher, and outcomes after surgery can vary from partial vision to very limited sight.

Because ROP can lead to other eye problems years later, children with a history of ROP generally need eye checks throughout childhood, even if their early exams were reassuring. Parents may want to watch for signs such as squinting, holding objects very close, tilting the head, or an eye that turns in or out, and report them at follow-up visits.

For children who do have lasting vision loss, early support makes a real difference. Low-vision services, early intervention programs, and educational support can help a child develop skills and independence. Many children with visual impairment from ROP go on to attend school, form friendships, and lead full lives with the right accommodations.

It is natural for parents to feel anxious about ROP. Talking openly with the neonatal and eye care teams, writing down questions before appointments, and keeping a record of examination results and follow-up dates can help families feel more in control.

Frequently asked questions

What is ROP in premature babies?

ROP, or retinopathy of prematurity, is a condition in which the blood vessels of the retina grow abnormally in a baby born early. It can range from mild changes that go away on their own to severe disease that can cause retinal detachment and vision loss. It is detected through eye examinations rather than by visible signs.

What are the symptoms of ROP?

In its early stages, ROP usually has no symptoms that parents can notice. Later or more severe disease may lead to abnormal eye movements, crossed eyes, a white pupil, poor visual tracking, or severe nearsightedness. Because early rop symptoms are absent, scheduled screening exams are the only reliable way to find it in time.

What causes ROP?

The main cause of ROP is premature birth, which interrupts the normal growth of retinal blood vessels. Very low birth weight, the need for oxygen therapy, and other complications of prematurity, such as infection or breathing problems, are associated with higher risk. ROP is not caused by anything a parent did during pregnancy.

How is ROP diagnosed?

ROP is diagnosed by an ophthalmologist who examines the retina after dilating the baby’s pupils with drops. The doctor uses a special lens and light, and sometimes a retinal camera, to look for abnormal vessel growth. Findings are recorded by stage and zone, and repeat exams are scheduled until the retina has developed fully.

What are the treatment options for ROP?

Rop treatment options include observation for mild disease, laser therapy to stop abnormal vessel growth, injections of anti-VEGF medication into the eye, and surgery such as scleral buckle or vitrectomy for retinal detachment. The choice depends on the stage, location, and speed of progression, and your baby’s eye doctor will explain which approach is being recommended and why.

Can ROP be cured, and will my baby see normally?

Many babies with mild ROP recover fully, and many with more advanced disease keep useful vision after treatment. However, some children have lasting effects such as nearsightedness, reduced side vision, or, in severe cases, significant vision loss. Outcomes vary, and no doctor can promise a specific result, which is why ongoing follow-up is so important.

Does ROP come back or cause problems later in life?

Once the retina has fully developed, ROP itself does not usually return. However, children who had ROP are at higher risk of nearsightedness, strabismus, amblyopia, glaucoma, and, less commonly, later retinal detachment. Regular eye examinations throughout childhood and sometimes into adulthood help catch these problems early.

When to see a doctor

All babies who meet screening criteria should have their scheduled ROP examinations, both in the hospital and after discharge, even if they seem to be seeing well. Do not skip or delay a follow-up appointment, because ROP can progress within days or weeks without any outward signs.

Seek prompt medical attention if you notice any of the following in a premature baby or a child with a history of ROP:

• A white, gray, or cloudy appearance in the pupil, especially in photographs
• Eyes that shake, wander, or do not move together
• One or both eyes turning inward or outward
• The baby does not look at faces or follow objects by the age expected for their corrected age
• Sudden redness, cloudiness, or swelling of the eye
• An eye that looks larger than the other or appears to bulge
• In an older child, sudden loss of vision, new floaters, flashes of light, or a shadow or curtain over part of the vision, which can signal retinal detachment

If your child has been treated for ROP and develops any sudden change in vision or eye appearance, this should be evaluated urgently by an eye care professional. When in doubt, it is always reasonable to have a concern checked rather than wait for the next scheduled visit.