Testing & Diagnosis for Retinopathy of Prematurity (ROP) in Children

If your child is born prematurely, there’s a 50-50 chance he will develop some degree of retinopathy of prematurity. Since the disease has no outward symptoms, you can’t “see” it — and neither can the doctors and nurses who work in the neonatal intensive care unit. That’s why infants at risk for ROP are routinely screened by pediatric ophthalmologists using special equipment.

In 2006, the American Academy of Pediatrics revised its guidelines for ROP screening. They include:

  • All infants with a birth weight of less than 1,500 grams (about 3.3 pounds) or a gestational age of 30 weeks or less should be screened by an ophthalmologist.
  • Infants with a birth weight of 1,500 and 2,000 grams or a gestational age of more than 30 weeks should be screened if other health troubles put them at high risk for ROP.
  • The first exam should occur four to nine weeks after birth, depending on how premature the baby is.
  • If the exam shows the retina is fully “vascularized” (its blood vessels have finished growing normally), no follow-up is needed.
  • If there are signs of ROP, however, the ophthalmologist will set follow-up exams to monitor the condition and determine when treatment is needed.

The screening exam may take place at your child’s bedside in the NICU or, if he’s already been discharged, at the ophthalmologist’s office. Here’s what’s typically involved:

  • dilating eye drops, to enlarge the pupil (giving the doctor a bigger “window” into the eye)
  • an eyelid speculum, which holds the eyelids open
  • a scleral depressor, which helps move the eye into different positions so the entire retina can be checked
  • an indirect ophthalmoscope, which has a special lens that sends a bright light into the eye, enabling the doctor to examine the retina

Doctors are also making increasing use of an innovative device called the RetCam, a special camera that takes high-resolution digital pictures of the retina. This provides detailed images that can be compared from one exam to the next to help track the health of your child’s eyes over time.

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

If your child is diagnosed with ROP, you probably already have some ideas and questions on your mind. But during the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling that you have the information you need.

Some of the questions you may want to ask include:

  • How severe is my child’s ROP?
  • How frequently do I need to bring him in for follow-ups?
  • Will he require medical treatment?
  • What is the treatment success rate?
  • Does the treatment have any complications?
  • What is the long-term outlook for my child?