Retinopathy of Prematurity (ROP)

What is ROP?

ROP is a sight-threatening condition caused by abnormal growth and development of blood vessels on the retina (the light-sensitive tissue lining the back of the eye).

 

What is the magnitude?

About 15 million babies are born prematurely, that is, sooner than expected, every year. About 20,000 of these eventually become blind while about 12,300 develop significant visual impairment as a result of ROP.

 

How does ROP occur?

Blood vessels develop and gradually spread towards the edges of the retina while a baby is still in the womb. The retina is the tissue that lines the back of the eye and is very important for sight. The process of blood vessel development and spread is usually completed within the first month of life. However, when a baby is born preterm, this process may be interrupted, meaning that nutrients and oxygen may not get to the edges of the retina where the vessels have not yet reached. To compensate for this, new vessels begin to form, but these are abnormal and very fragile. They tend to bleed easily and cause scarring of the retinal, and may eventually lead to detachment of the retina and blindness.

 

Who is at risk of developing ROP?

  • Pre-term babies (the earlier a child is born, the greater the risk)
  • Exposure to too much oxygen soon after birth
  • Low birth weight (usually <1500g; the smaller the baby, the greater the risk)
  • Neonatal infection
  • Anaemia

 

How can ROP be prevented?

Pre-term babies can be prevented from developing ROP by using the ‘POINTS’ strategy soon after birth, and by screening at risk preterm babies.

P – adequate Pain control (minimise painful events e.g. taking blood samples)

O – optimum Oxygen management (maintain oxygen saturation between 89% and 94%)

I– strict Infection control (strict hand washing before and after handling each baby)

N– adequate Nutrition (mother’s breast milk, with additional supplementation if required)

TTemperature regulation (e.g. kangaroo nursing, incubators,

SSupportive care (ensuring babies are well-positioned and as comfortable as possible)

 

Screening for ROP

Screening involves dilated examination of the eyes of babies at risk of ROP by an ophthalmologist at about the 21st -25th day of life. Depending on findings, a baby may be declared ROP-free, may require a second screening apointment, or may require urgent treatment.

 

 

Can ROP be treated?

If detected early, ROP can be treated by cryotherapy, laser or by injecting an anti-VEGF agent into the eye (which prevents growth of abnormal vessels)

 

What other eye complications can arise due to prematurity?

In addition to ROP, other complications that may arise due to prematurity include refractive errors, squint, cataract and glaucoma. Life-long follow-up by an ophthalmologist is therefore essential for all pre-term babies.

 

References

  1. Gilbert C, Quinn G. Retinopathy of Prematurity: it is time to take action. Community Eye Heal J. 2017;30(99).
  2. Phelps DL. Retinopathy of Prematurity : History , Classification , and Pathophysiology. Neoreviews. 2001;2(7).
  3. WHO Factsheet – Preterm birth [Internet]. WHO. World Health Organization; 2017 [cited 2017 Nov 29]. Available from: http://www.who.int/mediacentre/factsheets/fs363/en/
  4. National Eye Institute. Facts About Retinopathy of Prematurity (ROP) [Internet]. 2014 [cited 2017 Nov 29]. Available from: https://nei.nih.gov/health/rop/rop