What Is Retinopathy Of Prematurity (ROP)? – A Simple Guide For Parents

The joy of welcoming a premature baby often comes with extra medical attention and care. While doctors monitor breathing, feeding, and growth, there’s another critical area that parents must not overlook — their baby’s eyes.

One of the most important eye conditions seen in premature infants is Retinopathy of Prematurity (ROP). It’s a condition that affects the blood vessels in the retina — the light-sensitive layer at the back of the eye — and, if untreated, can lead to vision impairment or even blindness.

Dr. Vanuli Bajpai, MBBS, MS Ophthalmology (Gold Medalist), FICO, FMRF, explains that early screening and timely treatment can protect a premature baby’s eyesight and ensure normal visual development.

Understanding Retinopathy Of Prematurity

The retina is responsible for capturing images and sending them to the brain through the optic nerve. In full-term babies, retinal blood vessels are usually fully developed at birth. However, in premature babies (born before 34 weeks of gestation or weighing less than 2 kg), these blood vessels are still growing.

When a baby is born early, this normal growth process is interrupted. Abnormal blood vessels may develop, which can leak or cause scar tissue to form. In severe cases, this can pull on the retina and lead to retinal detachment, a serious cause of permanent blindness.

What Causes ROP?

The exact cause is complex, but several factors contribute to the development of ROP:

• Premature Birth: The earlier a baby is born, the higher the risk.
• Low Birth Weight: Babies weighing less than 1500 grams are particularly vulnerable.
• High Oxygen Exposure: Premature babies often need oxygen therapy for survival, but excessive or unmonitored oxygen can disrupt normal vessel growth.
• Fluctuating Oxygen Levels: Inconsistent oxygen levels in the blood can damage fragile retinal vessels.
• Other Risk Factors: Infections, blood transfusions, anemia, or breathing problems can also increase risk.

Dr. Vanuli Bajpai emphasizes that ROP does not develop because of something parents did or didn’t do — it’s related to the baby’s early birth and medical challenges.

How Common Is ROP?

With improved neonatal care, more premature babies now survive — but this also means more are at risk for ROP.

Globally, ROP affects thousands of infants each year, especially in developing countries where premature births are increasing.

The encouraging news: most ROP cases are mild and resolve naturally as the baby grows. Only a small percentage progress to severe stages needing medical or surgical treatment.

Symptoms – Why ROP Often Goes Unnoticed

In its early stages, ROP doesn’t cause visible symptoms that parents can recognize. The baby won’t show signs like redness or tearing. That’s why screening is crucial — it’s the only way to detect ROP before damage occurs.

In advanced cases, some warning signs may appear:

• Abnormal eye movements
• White or cloudy appearance in the pupil (leukocoria)
• Crossed eyes (strabismus)
• Poor visual response as the child grows

However, these appear late — making regular screening by an ophthalmologist essential for premature babies.

Screening And Diagnosis

ROP screening is a quick, safe, and painless procedure done by a trained ophthalmologist.

• First Screening: Usually performed between 3–4 weeks after birth or by 31 weeks postmenstrual age, whichever is earlier.
• Procedure: The doctor uses special dilating eye drops and a magnifying lens to examine the retina.
• Follow-ups: Depending on the baby’s eye condition, screenings may be repeated every 1–2 weeks until the retina is fully developed.

Parents should ensure timely screening appointments — delays can risk progression to advanced stages.

Stages Of ROP

ROP is classified into five stages, depending on severity:

• Stage 1: Mild abnormal vessel growth — usually heals on its own.
• Stage 2: Moderate abnormal vessel development — close monitoring needed.
• Stage 3: Blood vessels grow into the center of the eye — may require treatment.
• Stage 4: Partial retinal detachment.
• Stage 5: Complete retinal detachment — causes permanent blindness.

Early stages often resolve without intervention, but Stages 3 to 5 require prompt treatment.

Treatment Options

Treatment depends on the severity and progression of ROP:

• Laser Therapy: Destroys the peripheral areas of the retina to stop abnormal vessel growth.
• Intravitreal Injections: Anti-VEGF (Vascular Endothelial Growth Factor) injections help control abnormal vessel formation.
• Surgery (Vitrectomy or Scleral Buckling): For advanced cases with retinal detachment.

These treatments are highly effective when performed at the right time. With proper care, most babies maintain good vision as they grow.

Long-Term Follow-Up

Even after successful treatment or spontaneous resolution, premature babies should undergo regular eye checkups throughout childhood.

Some may later develop:

• Refractive errors (needing glasses)
• Lazy eye (amblyopia)
• Squint (strabismus)
• Early detection and correction ensure normal visual development.

FAQs – Retinopathy Of Prematurity (ROP)

1.Can ROP be prevented?

While premature birth cannot always be prevented, careful oxygen monitoring, good neonatal care, and timely eye screening can reduce the risk of severe ROP.

2. Is ROP painful for the baby?

No. The condition itself and its treatments are not painful. Babies are given comfort care and gentle handling during eye examinations.

3. Does every premature baby get ROP?

Not all. Many premature babies have normal retinal development, but every baby born early should be screened to be safe.

4.If ROP is detected early, can vision be saved?

Yes. With early diagnosis and appropriate treatment, most babies have excellent outcomes and normal vision development.

5. How long should follow-ups continue?

Until the retina matures completely and sometimes beyond infancy — your ophthalmologist will guide you on the schedule.

Expert Guidance By Dr. Vanuli Bajpai

Every premature baby deserves a clear, healthy start to life. Regular ROP screenings and early treatment can make the difference between lifelong vision and preventable blindness.

Dr. Vanuli Bajpai, MBBS, MS Ophthalmology (Gold Medalist), FICO, FMRF, specializes in pediatric and retinal care for newborns. With expertise in diagnosing and managing Retinopathy of Prematurity, she helps parents navigate this sensitive phase with confidence and care.

Schedule a Consultation With Dr. Vanuli Bajpai Today

Give your baby the gift of healthy vision — because early screening saves sight.