Retinopathy of Prematurity: Causes, Symptoms and Treatment

Retinopathy of prematurity (ROP) is a potentially blinding eye disease that affects premature infants and is the leading cause of blindness among children worldwide. It's particularly prevalent in Latin America & South East Asia where more premature babies are being saved, but few hospitals have the skills & resources to deliver the care needed.

Read below to find out more about this blinding condition and discover what our teams are doing to help combat retinopathy of prematurity and help babies see the world around them.

WHAT IS RETINOPATHY OF PREMATURITY?

Babies born at a very early gestation can develop ROP where blood vessels grow abnormally and uncontrollably causing damage to the light sensitive layer of the retina.

In the worst case scenario this can lead to bleeding and scarring that can pull the retina away from the wall of the eye (retinal detachment) putting the baby at risk of becoming blind.

Retinopathy of Prematurity Diagram

Diagram of the eye affected by retinopathy of prematurity

According to the World Health Organization 15 million babies are estimated to be born early each year and with pre-term birth comes the risk of blindness. The International Agency for the Prevention of Blindness tell us that 32,300 pre-term babies become permanently blind or visually impaired from ROP every year.

Retinopathy of prematurity is also known as Retrolental Fibroplasia or Terry Syndrome.

RETINOPATHY OF PREMATURITY CAUSES AND RISK FACTORS

According to International Agency of the Prevention of Blindness risk factors of ROP include:

  • Low birth weight (less than 1,500g) - the smaller the baby, the greater the risk
  • Babies born at 32 weeks gestation or less
  • Oxygen levels (which are highly toxic to blood vessels) too high during neonatal treatment
  • Sepsis
  • Chronic Lung Disease
  • Poor nutrition

RETINOPATHY OF PREMATURITY SYMPTOMS

Severe and untreated ROP can present some of the following symptoms:

  • White pupils, called leukocoria
  • Abnormal eye movements, called nystagmus
  • Crossed eyes, called strabismus
  • Severe nearsightedness, called myopia

There are several other maladies we see with retinopathy of prematurity – strabismus (or crossed eyes), amblyopia (weakness of one eye). Premature children in general tend to have some systemic problems if they are very premature – they may have cerebral palsy or other developmental anomalies. So, having a support system not only for the eye but for their general medical care is important.

Dr. Rosalind Stevens

Professor of Surgery, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center. Lebanon, New Hampshire

Dr. Ros Stevens examining a baby for Retinopathy Of Prematurity at Can Tho Children's Hospital in Vietnam

Dr. Stevens examining a baby for signs of ROP at Can Tho Children's Hospital in Vietnam

STAGES OF RETINOPATHY OF PREMATURITY

Retinopathy of prematurity is classed into five stages ranging from very mild to very severe progression. Most babies with stage 1 or stage 2 will need no intervention and live with normal vision.

However, the more severe stages can lead to severely impaired vision.

STAGE 1

Blood vessel growth is mildly abnormal but babies usually recover without any medical treatment.

STAGE 2

Blood vessel growth is moderately abnormal. Babies usually recover without any medical treatment.

STAGE 3

Blood vessel growth is severely abnormal and treatment may be required.

STAGE 4

Partial retinal detachment takes place which means the retina is pulling away from the back of the eye.

STAGE 5

Retinal detachment occurs, which means the retina has fully detached from the back of the eye leading to irreversible vision loss.

A baby is examined for Retinopathy of Prematurity in Binh Dinh, Vietnam

ROP screening of premature babies at Binh Dinh General Hospital in Vietnam

RETINOPATHY OF PREMATURITY PREVENTION AND TREATMENT

PREVENTING PRE-TERM BIRTH

Preventing premature births will reduce the incidence of babies developing ROP.

EARLY DETECTION

Having specialist ophthalmologists carefully monitoring and examining at-risk babies during the weeks after birth and before hospital discharge. The only way to determine if babies have ROP is to examine the inside of their eyes for abnormalities in the retina.

A pediatric ophthalmologist can detect changes in a baby's retina through proper examination using special instruments.

DELIVERY OF NEONATAL CARE

Providing better resources and equipment in low-to-middle income countries to manage the care of babies in neonatal units - especially in relation to monitoring the oxygen levels a pre-term baby is exposed to after birth. High levels of oxygen are damaging to blood vessels and linked to development of ROP.

LASER THERAPY OR FREEZING TREATMENT (CRYOTHERAPY)

This kind of therapy is used for treating advanced ROP and targets specific parts of the retina to stop the growth of abnormal blood vessels. Some cases are now treated with injections, which is used alongside laser therapy to stop the growth of abnormal blood vessels.

LONG-TERM FOLLOW UP

Children born pre-term have a greater risk of refractive errors and strabismus, and may have visual impairment so following up allows detection of further eye conditions caused by ROP.

WHAT IS ORBIS DOING TO COMBAT IT

We believe that no child should start out life blind from an avoidable cause. With the right awareness, knowledge and equipment, ROP is entirely preventable. Thanks to your support, our eye care teams are saving babies and infants from a lifetime of blindness.

At the fore, we're promoting the development of national ROP protocols and guidelines. Other specific initiatives include:

IMPROVING QUALITY OF PREMATURE INFANT CARE

We're helping improve standards of Neonatal Intensive Care Units (NICUs) through efficient delivery of oxygen therapy and ensuring universal screening for all babies at risk of ROP. We also work to improve the standards of ophthalmic facilities to diagnose, treat and follow up on premature infants with ROP.

DEVELOPING A TRAINING FRAMEWORK

We have developed a curriculum and training framework for NICU nurses and ophthalmologists. We're also providing training in laser and surgical treatment for eye care professionals to improve outcomes and avoid high complication rates.

Retinopathy of Prematurity specialist and Volunteer Faculty Dr. Peter Kertes lectures on our Flying Eye Hospital in Chittagong

ROP specialist and Volunteer Faculty Dr. Peter Kertes of Toronto, Canada lectures on our Flying Eye Hospital in Chittagong, Bangladesh

PROVIDING INTEGRATED CARE

By integrating neonatal and ophthalmic care, we're able to identify cases early and provide early timely treatment to prevent permanent blindness.

TECHNOLOGY FOR EYE CARE

We are in the process of developing an app to track patient care and outcomes to provide timely feedback and evidence. This way, we can advocate for greater investment in care for retinopathy of prematurity with hospital administrators and government.

WORKING WITH COMMUNITIES

At community level, we're prioritizing education and awareness for parents of children at risk of ROP, local healthcare providers and general practice physicians.

Retnopathy of prematurity simulation training in Chittagong of ROP through simulation training

Dr. Kertes working with a doctor in Bangladesh, helping to deepen the understanding of ROP through simulation training

We need your help.

Can you help us fight blindness caused by retinopathy of prematurity in communities across the world? No baby deserves to begin life blind for avoidable reasons.