Pediatric Retinopathy of Prematurity

Retinopathy of prematurity is an eye problem that can happen to premature babies. The retina lines the back of the eye. It receives light as it comes through the pupil. From there, the optic nerve sends signals to the brain. Retinopathy of prematurity is a problem of the blood vessels of the retina. It occurs in stages. It can cause bleeding and scarring throughout the retina. This may cause the retina to detach. A detached retina can cause loss of eyesight.

Healthcare providers don't know what causes this condition. Babies who are born too early (premature) or at a lower birth weight are more likely to get retinopathy of prematurity. In premature babies, the blood vessels of the retina may not have the chance to develop as they should.

Babies who are born prematurely are most likely to get this condition. Babies who weigh less than 2 pounds, 12 ounces and are born before 31 weeks of the pregnancy are at greatest risk.

Retinopathy of prematurity has no signs or symptoms. The only way to find it is through an eye exam by an eye care provider.

An eye care provider (ophthalmologist) will look at your baby's retinas. The eye care provider should have experience treating retinopathy of prematurity. Babies should be screened if they:

• Weigh less than 3 pounds, 5 ounces at birth. They should also be screened if they were born before 30 weeks of pregnancy.
• Weigh 3 pounds, 5 ounces to 4 pounds, 7 ounces at birth and have additional risk factors for the condition. They should also be screened if they were born after 30 weeks of pregnancy and have additional risk factors.

Eye care providers use a special system to describe retinopathy of prematurity. They use it to figure out treatment and the timing of follow-up exams. When the baby's eyes are checked, the eye care provider describes the stage and zone of the retinopathy. There are 3 different locations or zones of the retina where retinopathy can occur. There are 5 different stages of ROP. Eye care providers use these stages to keep track of how serious ROP is. The stages range from stage 1 (mild) to stage 5 (severe).

We offer:

• ROP screening expertise: Our team has years of experience treating retinopathy of prematurity. We provide screening exams and retinal consultations and treatment for hundreds of new patients seen annually in our NICU.
• Experienced NICU team: Our pediatric ophthalmologists are members of the comprehensive care team dedicated to supporting the multiple needs of babies born prematurely.
• Convenient follow-up care: Timely follow-up is key to achieving a good visual outcome. We see our ROP patients at our main Eye Clinic at Children's National and at our Specialty Care Locations closer to the community where you live.
• Advanced treatments: Some infants with ROP need urgent treatment. Our team is highly trained to determine the best course for your child. We will discuss with you the full range of treatments available today and help you choose the most appropriate and effective one for your infant.

We routinely screen all infants in the neonatal intensive care unit (NICU) who are at risk for ROP. We consider the following premature infants to be at risk:

• Born at or before 30 weeks gestational age
• Birth weight less than or equal to 3 lb., 5 oz. (1500 grams)
• Determined to have had a complicated neonatal course

We perform eye examinations every one to two weeks until the retina is fully mature or needs treatment. These exams take less than 15 minutes. We are sensitive to the needs of the most extreme premature babies and their stress level.

Children with ROP may need glasses early in life or experience other problems such as strabismus (misaligned eyes), amblyopia (“lazy eye”), glaucoma and cataracts. These problems can be easily treated and controlled if detected early. Our team is here to provide all of your long-term pediatric ophthalmology needs.

Our team of pediatric ophthalmologists is highly trained to identify infants needing urgent treatment. Our treatment options include:

• Laser therapy: Treats the peripheral retina to close abnormal blood vessels, prevent retinal detachment and save the central, vision-critical retina
• Intravitreal injection: Technique to inject medicine inside the eye that reverses the abnormal development of blood vessels
• Cryotherapy: Uses a freezing technique to stop further damage
• Scleral buckle: Silicone band placed around the eye to allow the retina to reattach
• Vitrectomy: Procedure that delicately removes scar tissue and allows the retina to reattach 

Preventing premature births is the key to preventing this problem. Finding the condition early and getting treatment can help prevent long-term vision problems.