Retinopathy of Prematurity
A Small Step Towards Preventing Infant Blindness
Premature infants, born before 34 weeks of gestation (about 6 weeks earlier than their due date), face a higher risk of various health complications compared to full-term infants (born between 37-40 weeks). One of these risks is Retinopathy of Prematurity (ROP), a condition affecting the developing blood vessels in the retina. ROP is the leading cause of childhood blindness in premature infants or those with low birth weight. In India, babies weighing less than 2000 grams (2 kgs) or born before 34 weeks of gestation are at risk of developing ROP.
Ashu Eye Hospital (Dr. Shahnawaz Kazi – Sr. Eye Surgeon & Retina Specialist) Diagnosis for Retinopathy of Prematurity) as ROP program. It is a platform that assists preterm babies born in neonatal intensive care units (NICUs), where ROP specialists may not be readily available. Trained imaging teams use specialized cameras to capture images of the infant’s retina and upload them to the platform for grading by Ashu Eye Hospital’s ROP team. In 2018, the Indian National ROP guidelines officially recognized imaging as an alternative screening method for ROP.
Ashu Eye Hospital is equipped to handle all forms of ROP treatments for newborns, thanks to a dedicated, state-of-the-art pediatric eye surgery operating room. Our retina eye center use OCT imaging to monitor ROP and assess vision development, including conditions like Cerebral Visual Impairment (CVI) and poor vision.
Risk Factors for Retinopathy of Prematurity (ROP)
The primary risk factors for ROP are premature birth (particularly babies born more than 12 weeks early) and low birth weight, which affects 11% to 56% of preterm infants. The retina develops significantly in the last three months of pregnancy. When a baby is born prematurely, this development is incomplete, increasing the risk of abnormal blood vessel growth in the retina, leading to ROP.
In addition to prematurity and low birth weight, other factors that elevate the risk of ROP include prolonged oxygen use for lung support, blood infections (sepsis), blood transfusions, jaundice, low weight gain, low platelet counts, anemia, and brain hemorrhages (intraventricular hemorrhage).
If your baby was born prematurely, it is important to have them screened for ROP. Ashu Eye Hospital recommends that premature babies and those weighing less than 2 kgs at birth undergo their first ROP screening within 30 days after birth, ideally before leaving the hospital. Early detection and treatment can significantly improve the chances of preserving vision.
Signs and Symptoms of Retinopathy of Prematurity (ROP)
The retina is crucial for vision, and any damage to it can result in blindness or vision loss. Unfortunately, ROP has no visible external signs in its early stages, meaning many parents may miss the opportunity for early screening. As ROP progresses to advanced stages, a white reflex (leukocoria) may appear in the center of the pupil. However, by this stage, which typically occurs between 4 to 6 weeks of age, it may be too late to prevent significant vision loss.
Subtle changes in the retina can only be detected by a pediatric retina specialist using specialized equipment. Ashu Eye Hospital recommends screening for all preterm infants soon after birth and again before discharge from the hospital. Early screening helps detect ROP before it progresses to a stage where it could lead to retinal detachment and irreversible vision loss.
Stages of Retinopathy of Prematurity (ROP)
ROP is graded in stages from 1 to 5, with Stage 1 being the mildest and Stage 5 the most severe.
- Stage 1: Mild abnormal blood vessel growth.
- Stage 2: Moderate abnormal blood vessel growth.
- Stage 3: Severe abnormal growth, which can cause bleeding, swelling, and leakage in the retina.
- Stage 4: The retina begins to detach, starting at the edges and eventually in the visual center (macula).
- Stage 5: Complete retinal detachment, leading to severe vision impairment or blindness.
An aggressive form, called Aggressive Posterior ROP (APROP), bypasses the early stages and rapidly progresses to stages 4 and 5. This form is difficult to diagnose and treat.
At Ashu Eye Hospital, the Pediatric Retina team provides treatment for all stages of ROP, ensuring early intervention to safeguard the baby’s vision.
ROP Screening
Early screening for ROP in premature infants is essential for preventing vision loss. Since there are no visible symptoms in the early stages, screening is the only reliable way to detect ROP. The national ROP guidelines (2018) in India recommend that babies born weighing less than 2000 grams or before 34 weeks of gestation undergo their first ROP screening before 30 days of age.
ROP screening continues even after discharge from the hospital, as the condition may not be immediately apparent. Specialized imaging equipment is used by our team to screen infants either in the NICU or at our hospital after discharge. If any signs of ROP are detected, our specialists will schedule follow-up exams and determine the need for treatment.
Diagnosis of Retinopathy of Prematurity (ROP)
Diagnosing ROP requires a trained ophthalmologist. Ashu Eye Hospital’s Pediatric Retina department uses the latest technology for detecting ROP in preterm infants. The examination is quick, painless, and involves dilating the baby’s pupils with eye drops. A specialized instrument, called an indirect ophthalmoscope, is used to examine the retina and blood vessels. A high-resolution digital camera may be used to capture detailed images for monitoring the baby’s condition.
If ROP signs are detected, the doctor will discuss further evaluations and treatment options with you.
Treatment of Retinopathy of Prematurity (ROP)
The treatment for ROP depends on the severity. Mild cases may resolve on their own without intervention. However, in more severe cases, treatment is necessary to prevent retinal detachment and preserve vision. Treatment is typically required for ‘Type 1 ROP’ and should ideally be done within 48 hours for the best outcome. Laser therapy under topical anesthesia is commonly used to treat affected areas of the retina. Approximately 90% of babies respond well to laser treatment. In some cases, injections into the eye (intravitreal) are used to reverse abnormal blood vessel growth, with laser therapy following later.
For advanced stages (4 and 5), retinal surgery may be required under general anesthesia, along with NICU support.
If left untreated, ROP can lead to permanent blindness or severe vision impairment. The success rate for treating Stage 5 ROP is very low, even with surgery.
At Ashu Eye Hospital, we offer comprehensive ROP treatments for newborns and young children in a modern pediatric eye surgery operating room. We use OCT imaging for monitoring infants for ROP and assessing their vision development.
Ashu Eye Hospital ROP Patient Process Flow
If your infant was born prematurely (more than 12 weeks early) or has low birth weight (less than 2 kgs), and hasn’t been screened for ROP in the NICU, schedule an appointment with our pediatric retina specialist. Your initial consultation will take approximately 2 hours if no additional consultations are needed and up to 4 hours if cross-consultations are required. During the consultation, our doctors and counselors will discuss the most suitable treatment options to preserve and improve your baby’s vision.
For more information or to book an appointment, please connect with us at +91 93223 64002. Meet our Senior Eye Surgeon & Retina Specialist, Dr. Shahnawaz Kazi, for expert advice and personalized care at Ashu Laser Vision & Ashu Eye Hospital. We look forward to assisting you with your eye care needs!