What is Retinopathy of Prematurity?
Retinopathy of Prematurity is a blinding disease, which occurs in preterm newborn babies. As the retina in these babies is not mature, it can develop abnormal blood vessels leading to bleeding or retinal detachment. Failure to screen such babies leads to irreversible lifelong blindness.
According to American Accademy of Ophthalmology (AAO), all infants with gestational age (GA) of ≤ 30 weeks or birth weight (BW) ≤ 1500 gm should be screened. According to National Neonatology Forum (NNF) guidelines, all preterm neonates ≤ 34 weeks GA or BW ≤ 1750 gm are to be screened. Newborns >34 weeks can also be screened considering other risk factors.
Screening is generally done within 4 weeks of birth by a trained Ophthalmologist. Treatment of ROP involves laser, intravitreal injections or surgery.
What are the stages of ROP?
There are 5 different stages of ROP, which ranges from stage 1 (mild) to stage 5 (severe) form of disease.
- Stages 1 and 2 — Babies in these stages usually get better without treatment and go on to have healthy vision. The disease is observerd at regular intervals to monitor.
- Stage 3 — The abnormal blood vessels grows and may lead to either bleeding into the eye or may cause traction leading to retinal detachment.
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- Stage 4 — Such babies have partially detached retinas and need treatment.
- Stage 5 — In this stage, the retina gets detached completely, which may lead to vision loss/blindness.
Both stages 4 and 5 are very serious. Babies in these stages often need surgery — but even with treatment, they may have vision loss. That’s why doctors usually start treatment in stage 3.
What are the symptoms of ROP?
There are no signs of ROP that you can see. In advanced cases of ROP, the retina may partially or completely pull away from its normal position at the back of the eye. This is called retinal detachment — and it can cause vision loss and blindness.
- The eyes wander or make unusual movements
- Eyes don’t follow objects
- They have trouble recognizing faces
- Their pupils look white
What's the treatment for ROP?
The density of treatment depends on the severity of the disease. Many babies with milder form of ROP, get better without treatment. In more severe forms mulitple treatment options are considred, which include:
Laser
In moderate to severe form of ROP, the retina is lasered. This is mainly done to prevent further progression
Intravitreal Injections
The new blood vessels formed are weak and leaky. Anit-VEGF injections are given to prevent the formation of such new vessels.
Surgery
There are 2 types of retinal surgeries for babies with partially or completely detached retinas (stages 4 or 5):
- Scleral buckle surgery : A flexible band around the sclera (the white part of the eye) is placed. The band supports the detached retina until the eye starts growing normally, then the doctor removes it.
- Vitrectomy : It is done to mainly clear the intra-ocular bleed and to remove the scarred tissue on the retina. Additionally, Laser is done to prevent further worsening of the disease.
The main goal of surgery is to keep ROP from getting worse and prevent blindness. In advanced cases, some babies with ROP will still have vision loss or blindness.