Prepared by Katherine Trimm
Retinopathy of Prematurity (ROP)
Description:
Retinopathy of Prematurity (ROP) is also known as retrolental fibroplasias. It is a
potentially blinding disorder which primarly affects premature infants weighing less
than 2 ¾ pounds, born before 31 weeks of gestation. The condition usually
develops in both eyes and is one of the most common causes for childhood vision
loss and can lead to lifelong vision impairment and blindness. In premature infants,
normal blood vessels stop growing and abnormal vessels begin to grow, reducing
the delivery of adequate oxygen supply to the retina. ROP occurs when abnormal
blood vessels grow and spread throughout the retina. These abnormal blood vessels
are fragile and can leak. Over time this vessel growth produces a fibrous scar tissue which
attaches to the retina and the vitreous gel that gives the eyeball its shape. This ring may extend
360 degrees around the inside of the eye. If enough scar tissue forms, it can begin to pull the
retina, detaching it, and, in some cases, causing blindness. This causes a retinal
detachment. Retinal detachment is the main cause of visual impairment and
blindness in ROP. Several factors contribute to the development of ROP. The
development of the eye begins around 16 weeks of pregnancy when the blood
vessels at the retina begin to form at the optic nerve. The blood vessels grow
gradually toward the edges of the developing retina, supplying oxygen and
nutrients. However, the last 12 weeks of pregnancy is when the eye develops
rapidly. If the baby is born prematurely, the blood vessels have not reached the
edges of the retina, and normal vessel growth may stop. The edges of the retina,
the periphery, may not get enough oxygen and nutrients. As a result, new
abnormal vessels may begin to grow, which can be fragile, weak, and may bleed,
leading to retinal scarring. When the scars shrink, they pull on the retina, causing
detachment.
There are five stages of ROP. Stage I, mildly abnormal blood vessels
develop, but improve with no treatment and normal vision develops. In
Stage II, moderately abnormal blood vessels develop but many children
improve with no treatment and normal vision develops. In Stage III,
severely abnormal blood vessels grow toward the center of the eye instead
of on the surface of the retina. While some children may improve without
treatment and develop normal vision; however, the blood vessels of the
retina may become enlarged and twisted, resulting in “Plus Disease,” which
requires treatment to prevent retinal detachment. Stage IV consists of a
partially detached retina caused by scar produced by bleeding, abnormal
vessels. In Stage V, the retina is completely detached, that if left untreated may
lead to severe visual impairment or blindness in the baby.
Treatment:
Physicians may use laser therapy or cryotherapy in treatment of ROP. While both
therapies destroy the peripheral areas of the retina, slowing or reversing the
abnormal growth of blood vessels, laser therapy “burns away” the periphery of the
retina and for cryotherapy, physicians use an instrument that generates freezing
temperatures to briefly touch spots on the surface of the eye that overlie the
periphery of the retina. The nature of the surgeries destroys peripheral vision while
saving the sharp, central vision. These treatments are used on infants with Stage
III or higher ROP. In addition to laser therapy, other treatment options include
sclera buckle and vitrectomy.
Caution:
Children who have ROP as infants should be watched for the following symptoms that
could signal underlying problems that may not surface until later:
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Holding objects very close
Difficulty seeing distant objects
Favoring or winking one eye
Reluctance to use one eye
Poor vision (previously undetected by the physician)
Sudden decrease of vision
Crossed or turned eye
Sources:
(2009, July). Retinopathy of Prematurity (ROP). Retrieved July 5, 2009, from National Eye Institute Web site:
http://www.nei.nih.gov/health/rop
Moss, K. (2003, Sept. 4). Retinopathy of Prematurity . Retrieved July 5, 2009, from Texas School for Blind and
Visually Impaired Web site: http://www.tsbvi.edu/Outreach/seehear/winter98/rop.htm
Richards, M.D., S. (2001). Retinopathy of Prematurity. Retrieved July 5, 2009, from Eye M.D.'s of Utah: Country Hill
Eye Center Eye Physicians and Surgeons Web site: http://www.checdocs.org/dr_retino.htm
(2008). Retinopathy of Prematurity. Retrieved July 5, 2009, from Eye Conditions Web site:
http://www.stlukeseye.com/Conditions/ROP
(2008, June 27). What is Retinopathy of Prematurity?. Retrieved July 5, 2009, from The Association for Retinopathy
of Web site: http://ropard.org/about_ropard.php