Retinopathy of Prematurity

Retinopathy of prematurity is a disease of small, premature babies. It is characterized by inadequate development of the blood vessels of the retina. When a child is born prematurely, the retinal blood vessels often have not developed to the far extent of the retina, and areas in the peripheral retina do not have blood vessels.

These areas of “avascular” retina that do not have blood vessels can be starved of oxygen. The response of the eye to the lack of oxygen is to create new retinal blood vessels. Unfortunately, these new vessels are often abnormal and do not provide oxygen to the avascular retina, and they can bleed and scar and lead to retinal detachments.

The management of babies with retinopathy of prematurity involves very frequent examinations to evaluate the condition of the retina. These examinations commonly are started while the baby is in the neonatal unit in the hospital, but continues with office visits after the baby has been discharged from the hospital. The worse the condition of the baby, the more frequent the examinations will be scheduled, and can be as often as weekly. The goal of the frequent exams is to observe the vessels of the retina and to institute timely therapy when high risk features are detected.

Babies that develop high risk features may be treated with laser therapy, which is done in the hospital, or with medications injected into the eye, which may be performed in a hospital or at the procedure room in the office, depending on the condition of the baby. Ultimately, the data strongly demonstrates that early treatment that prevents retinal detachments is preferable than surgery to fix a retinal detachment once it has developed.

Babies that have developed retinopathy of prematurity require long term follow up even if the disease is controlled. These patients can develop problems in their eyes, like hemorrhages inside the vitreous cavity or retinal detachments, even after reaching adulthood. In addition, they require a pediatric ophthalmologist to follow the child, in addition to the retina specialist, since these children can need glasses early in life, develop strabismus (crossed eyes) or amblyopia (lazy eye).