What is retinopathy of prematurity?
Retinopathy of prematurity (ROP) occurs in premature
babies when abnormal blood vessels and scar tissue grow
over the retina. The retina is the light-detecting layer
of cells at the back of the eye that allows us to see.
This condition usually affects premature babies weighing
less than three pounds at birth. Your baby's ophthalmologist
can detect ROP during an examination of your baby's
dilated eyes in the neonatal intensive care unit (NICU)
or nursery.
What causes ROP?
The causes are not completely understood. The retinal
blood vessels in some very small, premature babies seem
to develop abnormally during the therapy necessary for
the infant's survival.
It was once thought that oxygen, given to almost all
premature babies, was entirely responsible for all cases
of ROP. Newer evidence indicates this is not true. How
premature your baby is and his or her birth weight are
factors which appear to influence ROP. For example,
a baby who weighs three pounds at birth has about a
5% chance of developing ROP; an infant weighing less
than two pounds has a 40% chance of developing ROP.
Will ROP affect vision?
It is difficult to predict whether the eyesight will
be affected when the diagnosis of ROP is made. In many
infants, the abnormal blood vessels shrink or go away
without affecting vision.
In others with more extensive disease, bleeding and
scar tissue may lead to distortion or detachment of
the retina. This may result in moderate to severe loss
of vision.
Only a very small percentage of babies become blind.
Nearsightedness (myopia) is common in children with
ROP. Glasses may improve the vision of these children,
unless the eye is badly damaged.
Can ROP be prevented?
Unfortunately, laboratory and clinical research has
not yet found a way to prevent ROP in all babies. The
sophisticated medical care provided in modern neonatal
intensive care units has improved the survival chances
of very small babies. Because more premature infants
survive, ROP has become more common.
Can ROP be treated?
Most babies' eyes with ROP do well without any treatment.
In more severe cases, both cryotherapy (freezing) and/or
laser surgery may be used. The pen-like tip of the cryotherapy
instrument, a cryoprobe, briefly freezes side areas
of the retina through the outer wall of the eye.
Laser photocoagulation surgery may also be used to
treat the side areas of the retina.
When successful, treatment can slow down or reverse
the abnormal growth of blood vessels and scar tissue
in more severe ROP.
It may be necessary for an ophthalmologist to examine
a baby frequently while the infant is in the NICU or
nursery before he or she can recommend treatment. Important
factors in the decision include where ROP is located
in the eye, how severe it is and how it is progressing.
Even with treatment, there is still a definite risk
of serious vision loss. The long-term effects of cryotherapy
and laser surgery for ROP are not known, but research
studies are being conducted to answer this question.
If severe ROP disease pulls the retina out of place,
more complex surgical procedures can sometimes restore
limited vision. Other ROP complications such as glaucoma
and misaligned eyes may also require surgery later in
life.
Periodic eye examinations will be necessary as your
baby grows, to ensure that his or her vision is developing
as normally as possible.
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