Retinopathy of Prematurity

What is retinopathy of prematurity?

Retinopathy of prematurity is an eye problem that happens 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.

What causes retinopathy of prematurity?

Doctors 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.

Who is at risk for retinopathy of prematurity?

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.

What are the symptoms of retinopathy of prematurity?

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

How is retinopathy of prematurity diagnosed?

An eye doctor (ophthalmologist) will look at your baby's retinas. The doctor 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 or pregnancy.
• Weigh 3 pounds, 5 ounces to 4 pounds, 7 ounces at birth and are at higher risk for the condition. They should also be screened if they were born after 30 weeks of pregnancy but are at higher risk.

Doctors use a special system to describe retinopathy of prematurity. They use it to figure out treatment and timing of follow-up exams. When the baby's eyes are checked, the eye doctor describes the stage and zone of the retinopathy. There are 3 different locations or zones of the retina that the retinopathy can occur. Zone I is the central zone. It is at the back of the eye and extends from the optic disc to twice the distance between the macula and subtending. Zone II forms a circle outside zone I from the optic nerve to the nose. Zone III is the remaining temporal crescent of the retina.

How is retinopathy of prematurity treated?

Your baby will be checked regularly, based on his or her condition. That is all most babies need. Retinopathy of prematurity goes away without treatment.

If your baby needs treatment, the doctor can use a laser to stop the growth of abnormal blood vessels. Or the doctor may use cold therapy (cryotherapy). Some forms of the condition are treated with injections. But the long-term effects of these injections aren’t yet known.

Two surgeries may be done for babies with partial or total retinal detachment:

• Scleral buckling. In this surgery, a band is placed around the eye to push a detaching retina back in place.
• Vitrectomy. In this procedure, the surgeon removes the gel-like substance inside the eye. This lets the surgeon better reach the back of the eye. He or she then injects a substance to hold the retina in place.

After treatment, your baby will be checked often. Your baby should have regular exams by an eye doctor.

Can retinopathy of prematurity be prevented?

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

Key points about retinopathy of prematurity

• Retinopathy of prematurity is an eye problem that happens to premature babies.
• The earlier babies are born and the lower their birth weights, the greater the risks for the condition.
• Most cases of retinopathy of prematurity go away without treatment. When needed, the doctor can use a laser to stop the abnormal growth of blood vessels in the eye.
• Ongoing follow-up with an eye doctor is very important.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.