Patients & Public – ROP

ROP is not present at birth but starts to develop a few weeks after birth. Although ROP is more common in preterm babies who have been sick, it can also develop in babies who have not had many problems and are doing well. If the neonatologist or pediatrician has said that your baby needs to be examined for ROP then it is important that you follow this advice. In many babies only one examination is needed and the eye doctor can give you the all clear. Other babies need several examinations and only a few develop severe ROP which needs treatment.

In ROP the changes are inside the eye and are not visible from the outside – the eyes appear entirely normal. Special equipment is needed to see inside the eye.

Babies who are born up to four weeks preterm are at minimal risk of ROP and so are not usually examined. Babies who are more than four weeks premature are at risk, and the more preterm the baby the greater the risk. Most countries have guidelines on which babies need to be examined, which usually includes how preterm the baby was and how much they weighed at birth. Some countries also include whether the baby has been sick or needed a lot of oxygen.

The reason why regular eye examination starting a few weeks after birth is so important is because if severe ROP is not detected and treated it can lead to loss of vision. Once vision has been lost little can be done to improve it. Timely screening, starting 25-30 days after birth is, therefore, extremely important.

Treatment is only needed for the severe forms of ROP, which only develop in a few babies. Treatment needs to be given by an experienced ophthalmologist (eye doctor) within two-to-three days of diagnosis. The commonest form of treatment is laser, which is a special type of bright light. Sometimes the other type of treatment is needed, which entails an injection of a special medication called AntiVEGF.

If your baby needs treatment the ophthalmologist will explain which type of treatment would be best for your baby, and where the treatment will be given. If your baby is still an inpatient on the neonatal unit, the treatment is likely to take place in the neonatal unit. If your baby has already been discharged from the unit, the ophthalmologist will tell you where the treatment will be performed, which is likely to be in the eye department or hospital.

It is important that you contact the neonatologist or pediatrician in the neonatal unit and ask them when the ophthalmologist will next visit the unit. This should be done as soon as possible.

After laser treatment, the ophthalmologist who did the treatment will need to examine your baby within two weeks to make sure that the treatment is effective. Sometimes further treatment (laser or an injection) is needed. Regular follow up after laser treatment is also very important, as there is a risk that your baby may become short-sighted. If this happens they will need to wear spectacles to ensure that they can see clearly. Other eye conditions, which are less common after laser treatment for ROP, include squint and cataract, both of which can be treated.

Once you have been told that the laser treatment has been effective, your baby should be examined again at six months of age by an experienced ophthalmologist, preferably one with expertise in children’s eye conditions (paediatric ophthalmologist). How often your child is examined after that will depend on whether the ophthalmologist finds any problems, but an annual examination by a paediatric ophthalmologist during the pre-school-age years is highly recommended.