Retinopathy of Prematurity
Retinopathy of prematurity (ROP), also known as retrolental fibroplasia (RLF) and Terry syndrome, is an eye disease that usually affects premature infants born prior to 31 weeks gestation and weighing less than 3 pounds. It is a growing concern worldwide, because advances in neonatal care are enabling more premature babies to survive.
A 2018 retrospective cohort study published in JAMA Ophthalmology found that approximately 12.5% of premature babies screened for ROP at various medical centers developed severe ROP.
This condition generally affects both eyes, and usually resolves on its own. In more severe cases it can result in vision loss and total blindness, if left untreated.
What Causes Retinopathy of Prematurity?
The retina is the nerve layer at the back of the eye. When a baby is born prior to 31 weeks gestation, the retina’s tiny blood vessels aren’t fully developed. This makes the blood vessels fragile and prone to breaking and leaking fluid. Bleeding from these fragile blood vessels may scar the retina and stress its attachment to the back of the eye, causing partial or complete retinal detachment and potentially blindness.
Moreover, when vital oxygen is delivered to premature infants to help them breathe, their risk of ROP increases. That’s because the essential higher levels of oxygen in the body can increase the number of these fragile retinal blood vessels.
Risk Factors for Retinopathy of Prematurity
A premature baby’s chances of developing ROP are higher with:
- Birth prior to 31 weeks gestation
- Low birth weight – under 3 pounds
- Respiratory distress
- Blood transfusions
- Poor health overall
Stages of Retinopathy of Prematurity
There are five stages of ROP, ranging from mild to severe. Diagnosis is generally confirmed within the first two stages.
- Stage I: Mild abnormal blood vessel growth that usually improves without treatment.
- Stage II: Moderate abnormal blood vessel growth that usually improves without treatment.
- Stage III: Severe abnormal blood vessel growth toward the center of the eye. Although some Stage III cases will improve without intervention, treatment may be required if the retinal blood vessels begin to enlarge and twist. This signals the development of a condition called ‘plus disease’ which increases the risk of retinal detachment.
- Stage IV: Partially detached retina that requires prompt treatment to prevent vision loss and permanent blindness.
- Stage V: Completely detached retina, signaling the end stage of the disease, requiring prompt treatment to prevent severe vision loss and permanent blindness.
How Is Retinopathy of Prematurity Treated?
About 88% to 90% of ROP cases are mild and generally resolve without treatment. However, a small percentage of infants are diagnosed with severe ROP and require prompt medical attention to prevent vision loss.
Research has shown promise in treating advanced cases of ROP with a combination of laser and cryotherapy therapy and medication.
Later stages of ROP are treated using these various methods:
Laser therapy and Cryotherapy
Both laser therapy and cryotherapy are used for stage III of ROP when a diagnosis of plus disease is confirmed.
While laser therapy ‘burns’ the edges of the retina to seal the retina to the underlying support layers, cryotherapy ‘freezes’ the edges of the retina. However, cryotherapy is rarely used nowadays because outcomes from laser therapy are generally better.
Both laser surgery and cryotherapy require general anesthesia, which may be risky for preterm infants.
It’s important to be aware that although these treatments can help save an infant’s central vision, due to the nature of the treatment, they usually cause some peripheral vision loss.
Scleral buckle
A scleral buckle is used for the treatment of stage IV or V of ROP to prevent retinal detachment. It involves wrapping a tight silicone band around the eye to prevent the vitreous gel from pulling on the retinal scar tissue.
Vitrectomy
A vitrectomy is a procedure used for stage V of ROP to eliminate the threat of retinal detachment. The procedure involves the removal of the vitreous in the eye to allow the surgeon to cut away any retinal scar tissue. After the vitreous is removed, it is replaced with saline solution.
Eye injections
Eye injections of anti-VEGF medication may be used to treat aggressive ROP in stage III or later.
Anti-VEGF drugs work by blocking the overgrowth of blood vessels in the retina. The medication is injected into the eye while the infant is briefly under general anesthesia. Although these injections have not yet been approved by the FDA to treat ROP specifically, some medications approved for other uses are being explored as alternatives to laser therapy, or to be used in conjunction with it.
Eye injections require lower levels of anesthesia and preserve more retinal tissue when compared to laser therapy.
Complications of Retinopathy of Prematurity
Although various ROP treatments can help to reduce the risk of permanent vision loss and blindness from retinal detachment, in some cases retinal scarring or partial retinal detachment can still occur. Some babies with ROP will still become legally blind. Retinopathy of prematurity also increases the risk of developing other eye conditions in the future, including:
- Retinal detachment
- Myopia (nearsightedness)
- Strabismus (crossed eyes)
- Amblyopia (lazy eye)
- Glaucoma
How We Can Help
If your baby was born with ROP and diagnosed with any degree of vision loss, we at Low Vision Center in LOCATION1 are here to support their visual development.
We offer a variety of low vision aids and devices to help your child perform daily tasks with ease and enable them to reach their potential.
We are here for you and your child and will provide continual visual support, according to your child’s needs. Contact us today!
Our doctors and staff provide low vision services with the utmost care and are here to answer any questions and concerns you may have along the way.
Our practice serves patients from CITY 1, CITY 2, CITY 3, and CITY 4, and surrounding communities.