by: Luetwinta Breedlove, BSN, RN
Defining Retinopathy of Prematurity (ROP)
Retinopathy of Prematurity (ROP) is an eye disease that occurs when abnormal blood vessels start to grow in the layer at the very back of the eyeball (retina). When a baby is born too early, the normal growth process of healthy blood vessels in the retina become interrupted, therefore new blood vessels can start to form abnormally. This problem may lead to vision deficit or even blindness, when severe, if not monitored as recommended after diagnosis.
Who is at Risk for ROP?
Babies born before 31 weeks in length of pregnancy or weigh less than 3.3 pounds at birth are at risk for ROP due to the retinas not being fully developed once they are born. Babies born even younger and smaller with additional medical problems are at even greater risk for ROP.
Signs and Symptoms of ROP
Although there could be changes in a baby's retinas, these changes are not easily visible so an eye exam is needed by an eye doctor (ophthalmologist).
How is ROP diagnosed?
All babies born less than 31 weeks in length of pregnancy or weigh less than 3.3 pounds and those who may be older in length of pregnancy and have other risk factors for ROP will be examined by an eye doctor (ophthalmologist). The first exam may be done around 4 to 8 weeks after birth. The day of examination, the ophthalmologist will call the neonatal intensive care unit (NICU) to notify when he or she will be arriving to see your baby.
At this point, the nurse will administer dilating drops into the baby's eyes to make the pupils bigger. Just prior to the exam, additional drops will be administered by the eye doctor (ophthalmologist). This lets the eye doctor (ophthalmologist) see blood vessels on the inside of the eye. During this initial exam, if abnormal blood vessels are seen, ROP is diagnosed and rated from stage 1 to stage 5 along with the location of the blood vessels. Depending on the results of this exam and the baby's age, follow-up exams will be needed every 1 to 3 weeks.
Five stages of ROP
Stage 1 & 2: mild to moderate abnormal blood vessel growth. Babies usually get better without any treatment but continue to be monitored.
Stage 3: Severe abnormal blood vessel growth. Some babies may not need treatment in this stage but others may need treatment to stop abnormal vessels from damaging the retina and causing retinal detachment which can cause vision loss.
Stage 4: Severe abnormal blood vessel growth with partially detached retina. Treatment is needed at this stage.
Stage 5: Total retinal detachment. Treatment is needed. Even with treatment, loss of vision and blindness may occur.
Treatment
Often mild ROP needs no treatment, but babies with moderate to severe ROP may need treatment. When treatment is necessary, the options can include one or more of the following:
Laser therapy (photocoagulation). This treatment can help keep ROP from getting worse and help protect your baby's vision.
Injections. Medicines called anti-VEGF will be injected into your baby's eyes. These medicines work by blocking the growth of blood vessels.
Scleral buckle surgery. A flexible band is placed around the white part of the eye (sclera) which supports the detached retina until the eye starts growing normally, then it is removed.
Vitrectomy. Small openings in the eye wall are made to remove the gel-like substance that fills the back of the eye (vitreous) and is replaced with saline solution. Scar tissue is then removed from the retina.
These treatments depend on the severity of the disease. Your baby's healthcare provider will talk to you about which treatment is right for your baby and when treatment will start.
Because retinopathy of prematurity (ROP) primarily affects babies who are born early, it is more likely that at least the first eye exam will be done while they are still in the neonatal intensive care unit (NICU). If your baby will be discharged before the initial eye exam or your baby has had the initial eye exam and a follow-up date has already been scheduled, it is of most importance to make that appointment and all other appointments thereafter to ensure the well being of your baby's vision.
Sources:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/retinopathy-of-prematurity Assessed and Endorsed by the MedReport Medical Review Board