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Retinopathy of Prematurity
By Barry Bloom, MD
Premature infants are not born with retinopathy but with incomplete development of the blood supply to the retina.  The retina is the light sensitive internal lining of the eye.  Infants at risk for developing ROP are infants who are extremely premature, i.e. a birthweight of less than 1500 grams or a gestational age of less than 32 weeks.

Blood vessel development is complex in the eye, one system of blood flow is present early in development, then at about 16 weeks, new tissues grow from the optic disc to stimulate growth of blood vessels in the retina.  This is completed 2-3 months after full term birth.  ROP occurs when the development of the blood vessels is abnormal.

Retinopathy is a progressive disease; it starts around the fourth to tenth week after birth. It has several stages.  Not all infants will progress through all the stages.  Stage one is when there is a clear demarcation between the mature and immature retina.  Stage 2 displays a rolled edge of scar tissue as a demarcation line.  Stage 3 is when there are new and abnormal blood vessels growing into the scar tissue.  In Stage 4 the scar tissue causes the retina to pull away from the back wall of the eyeball.

There are four treatments for ROP.  A qualified opthalmologist will help define what therapy would be indicated and at what stage intervention would be helpful.  The three options are cryotherapy where the back of the eyeball is touched with a probe which freezes the eye and kills the scar tissue.  Laser has surpassed cryotherapy recently because it results in less pain, swelling after the procedure, and less need for anesthesia.  Scleral buckling or vitrectomy are rare procedures that are reserved for infants who have suffered retinal detachments.

There are excellent materials for parents provided by the American Academy of Opthalmology and the IRIS Medical Instruments company.  If you are concerned about your infant's status, check with your infant's neonatologist for current information regarding the screening criteria used in their facility.  Recent changes in the Academy of Pediatrics guidelines have decreased the number of infants who need screening for ROP as the risk is very low.

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