 Retinopathy of Prematurity
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Retinopathy of prematurity (ROP) is a disorder of the blood vessels of the retina (the light sensitive part of the eye). ROP is most common in premature babies. Generally, the more premature the baby and the lower the birthweight, the greater the risk for developing ROP. This disorder is sometimes called retrolental fibroplasia.
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The exact mechanism of ROP is not fully understood. The retina is the thin layer of light-sensitive nerve fibers and cells that covers the inside and back of the eye. The blood vessels of the retina are not completely developed until the baby reaches full term. When a baby is born prematurely, these developing blood vessels are vulnerable to changes in oxygen levels. Premature babies are more likely to have breathing problems that can cause low oxygen in the blood. They are also more likely to need oxygen therapy. It is thought that too much oxygen or lowered oxygen levels can lead to the growth of abnormal blood vessels, or damage and scarring of existing blood vessels in the retina. The scarring and bleeding can lead to retinal scarring or detachment from the back of the eye, resulting in vision loss.
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There are four stages of ROP, from a mild Stage 1 to severe Stage 4 when the retina detaches in the eye. Fortunately, about 90 percent of babies with Stage 1 and 2 ROP show improvement without treatment. However, about half of babies with Stage 3 and most of those with Stage 4 may develop serious eye damage. Each year, approximately 400 to 600 children are blinded by ROP.
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In 1997, the American Academy of Pediatrics (AAP) developed recommendations for babies at risk for ROP. These guidelines include the following:
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- eye examination, by a qualified ophthalmologist, for low birthweight and/or premature babies who are at risk for ROP
- eye examination should be done at 4 to 6 weeks of age, or when the baby reaches 31 to 33 weeks gestational age
- follow-up eye examinations at appropriate times
- considering babies with severe categories of ROP for treatment within 72 hours of diagnosis
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Early diagnosis of damage is important in the treatment of ROP. Babies who develop severe ROP may benefit from a treatment called cryopexy that uses freezing to stop further damage from occurring. Another treatment uses laser photocoagulation to create small burns, thus, producing scars. These scars seal the borders of the retina helping prevent detachment. In some cases, vitamin E is used as a therapy for ROP, but there are no proven benefits of this therapy. Studies are underway to determine if lowering the brightness of lights around babies can help prevent ROP.
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Preventing premature births is the key to preventing ROP. However, research is ongoing to find ways to treat this and other problems of premature babies.
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