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Retinopathy of Prematurity (ROP)

Overview
Causes
Symptoms
Risk Factors

Prevention
When To Seek Help
Treatment Options
Where To Seek Treatment

Singapore General Hospital
Contributed by Singapore General Hospital

Overview

Retinopathy of Prematurity (ROP) is due to an abnormal growth of blood vessels in the baby's eye. It is most common in babies who are very premature (more than 12 weeks early. In the baby’s development, blood vessels grow from the back central part of the eye out towards the edges. This process is completed just a few weeks before the normal time of delivery. In premature babies, this process is not complete. If blood vessel grows normally, the baby does not develop ROP. If the vessels grow and branch abnormally, the baby has ROP.


Causes

Doctors do not fully know all the factors leading to ROP. What is clear is that the smallest and sickest babies are at highest risk of ROP.

In the 1940's and 1950's, premature babies were often placed in oxygen whether or not they had lung problems or needed extra oxygen. Some of these babies developed Retrolental Fibroplasia, a condition like advanced ROP. Today, the use of oxygen is carefully monitored so babies get the right amount of oxygen into their blood, not too little or too much. In fact, enough oxygen in the blood is important for healing ROP.


Symptoms

There are no symptoms of ROP. Infants, especially premature ones, must be screened by an ophthalmologist.


Risk Factors

Premature babies who are born under 30 to 33 weeks of gestation are at higher risk of developing ROP than babies at over 34 weeks gestation.

Premature infants more frequently need spectacles in early childhood than children who were not born premature. This may be the case even if your child did not have ROP, but it is more common in children with ROP. It is also possible to develop "lazy eye" (amblyopia) or wandering eye (strabismus). Severe ROP can lead to blindness. 

Primary risk factors:
Premature babies born under 30 to 33 weeks of gestation have high risk of ROP.


Prevention

The best way to prevent ROP is to avoid premature birth. Other measures include close monitoring of oxygen needs in premature babies. The baby should also have regular eye examinations by an ophthalmologist, especially if he or she has a high risk of ROP.


When To Seek Help

Babies born at less than 30 weeks gestation and weigh less than 1.3kg at birth should be screened for ROP, regardless of whether they had received supplemental oxygen. Babies who had a stormy neonatal period and need prolonged respiratory support with supplemental oxygen (especially if they were born under 35 weeks gestation) should also have their eyes checked.


Treatment Options

Treatment of ROP lowers the chance of blindness, but it does not always prevent it. If your baby is at risk of ROP, an ophthalmologist will check your baby’s eyes. These tests start at about four to six weeks of age and happen regularly until the eye vessels have grown to the edges.

If the ophthalmologist sees any abnormal growth of blood vessels, he or she will record the extent of ROP, called Staging. Infants who have ROP need more frequent eye tests to watch for progress of the condition.

The treatment depends on the stage of the blood vessel growth. In Stage I and early Stage II, treatment is usually not needed. These stages may resolve by themselves without further growth of the abnormal vessels. Infants with Stage III may require treatment to stop the growth of abnormal vessels.

To treat ROP, the inner lining of the eye at the ends of these vessels is killed to prevent further abnormal growth of the blood vessels. This prevents the inner lining (retina) from being pulled away from the outer lining (detached) by the abnormal vessels.

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