Retinopathy of
Prematurity
Region 2
Michelle Kirby, Tracie Jenness, Debbie Minshew
What is Retinopathy of Prematurity?
Retinopathy of Prematurity is an eye disorder that
primarily effects premature infants of low birth
weight and is the leading cause of vision loss in
children.
Laura Maikata
What parts of the eye are effected?
ROP causes unnatural growth and development of the veins in the retina. In
advanced stages, a ridge is formed on the retina where the veins can spread and
begin to grow into the vitreous humor. This abnormal growth can eventually
detach the retina, causing partial and even full vision loss.
geteyesmart.org
What Causes ROP?
The reason why retinal vessels begin to grow abnormally in preterm babies is
still largely unknown. In the 1950’s it was discovered that an increase in oxygen
levels used to incubate preterm babies played a major factor in developing ROP.
Some modern research has been done that suggest the lack of certain growth
hormones that were being received in utero might also be one of the leading
factors.
Typical eye development and preterm ROP development
What Causes ROP?
The blood vessels in a baby’s eyes begin developing at 3 months gestation.
Blood vessels begin to develop in the macula of the retina.
If born during vascularization, a demarcation line typically occurs
and the vessels may stop growing.
Between 28-40 weeks there is rapid vascularization of the retina.
The blood vessels in the retina grow rapidly, branching out toward
the periphery.
The blood vessels in the retina are extremely sensitive and fragile,
abnormal growth may occur. Blood vessels in the retina may begin
to grow into the vitreous humor, pulling the retina inward which
could cause retinal detachment.
Vascularization is completely developed
Normal visual function develops and acuity strengthens.
ROP becomes more stable, but is still monitored annually for
complications.
Risk Factors
• Any baby born before 30 weeks gestation
• Low birth weight
• Any other symptoms that can cause low birth weight or premature births such as:
•
•
•
Anemia
Blood transfusions
Respiratory disease
• In the past, too much oxygen was used in incubation of preterm babies and caused the vessels of the retina
to grow abnormally.
• Today, oxygen levels are better monitored and all baby born before 30 weeks or under 3 pounds are screened
for ROP.
Stages and Classification of ROP
ROP has five stages of
development with 1 being
the least effected, to 5
being the most severely
effected. The area of the
retina that is effected is
also classified into three
zones which measures
how far the disease is
progressing into the retina.
Stage 1
In stage 1 ROP, there is a line or demarcation
between the vascularized portion of the retina.
This is the mildest form of ROP and will usually
spontaneously begin to develop normally,
needing no treatment.
Stage 2
In stage 2, the demarcation line develops a
ridge of tissue. This is considered a moderate
form of ROP and will be monitored closely.
At this stage, normal develop can still occur,
or there may be a worsening of the condition.
Stage 3
• In the third stage of ROP, the veins begin to pile
up on the ridge created on the retina and begin to
branch out into the vitreous humor. Stage 3 is
classified further as mild, moderate to sever
depending on the amount of scar tissue
developed at the ridge.
Earl Palmer, M.D., Oregon Health Sciences University
Stage 4
4A
In stage 4, the scar tissue that developed in the
previous stages is now pulling the retina and
causing detachment. Stage 4 is classified as 4A
and 4B. In stage 4A, the retina has begun to
detach in zones 2 and 3, causing peripheral
vision loss. In stage 4B, the detachment has
entered into the macula causing more severe
central vision loss.
Cybersight
4B
Stage 5
Stage 5 is a complete detachment of the retina. The
retina takes on a funnel shape connecting from the
optic nerve to the front of the eye. At this stage,
vision cannot be restored and blindness occurs.
Cybersight
Plus Disease
Plus disease is a more aggressive form
of ROP and a sign of rapid
development of the disease. Plus disease
can become present at any stage of
ROP. In plus disease, the blood vessels
are growing at a rate that they become
engorged and twisted. Infants with plus
disease will most likely need treatment.
Oculist
Stages
Stages
Eye Condition
Prognosis
1
Blood vessel growth is mildly abnormal
No treatment, normal vision will develop
2
Moderately abnormal blood vessel growth
Most children will need no treatment and normal
vision will develop
3
Severely abnormal growth of blood vessels mostly
toward the center of the retina, some vessels
becoming enlarged and twisted
In some children, vision will resolve with no
treatment, with more severe vessel abnormalities,
called “plus disease,” treatment can prevent retinal
detachment, but there is a loss of peripheral vision.
4
Partially detached retina
If no treatment, partial vision loss
5
Fully detached retina
If there is no treatment, can lead to blindness
Effects on the visual system
Most children diagnosed with ROP begin to have
normal vascular growth and typical vision
develops. However, children with Retinopathy
of Prematurity will more than likely develop
acuity problems and in advanced cases, ROP can
also cause partial field loss to a total loss of
functional vision.
http://www.cs.utah.edu/research/groups/percept/
DEVA/images/vissim-lab-central-field-loss.jpg
Treatments
In majority of babies diagnosed with ROP, the
blood vessels will heal within the first 4 months of
life and no treatment will be needed.
However, more advanced stages of ROP will
require treatment to halt the growth of the
destructive blood vessel growth, partial or full
reattachment of the retina, and remove scar tissue.
serviceartist.net
The most common treatment for ROP is laser therapy or cryotherapy.
Photocoagulation, or laser therapy, uses a diode
laser mounted on an ophthalmoscope to create
tiny laser burns in the periphery of the retina to
prevent further abnormal vessel growth.
AAPOS
Cryotherapy
Cryotherapy, uses a pen-like instrument called
a cryroprobe to freeze the periphery of the
retina through the eyes outer wall. Cryotherapy
has been largely replaced by laser therapy.
However, it is still used if retina cannot be
fully seen.
http://salemretina.com/info/treatment/las
er_and_cryotherapy/
Both of these treatments cause field vision loss because it destroys parts of the retina. The main goal
in treatment is to preserve the macula and the central portion of the retina for optimal functional
vision.
If the child’s retina become severely detached, surgery might also be
recommended.
Scleral buckling is sometimes
used to help push the retina into
the back of the eye. This is done
by placing a silicone band
around the eye.
Jimpitch.com
Vitrectomy
Vitrectomy is another surgery that can be
done in which the vitreus is removed in
order to remove scar tissue, The eye is then
filled vith saline so the retina can flatten
back out against the wall of the eye.
http://www.oneclearvision.org/treat
ment-for-eye-floaters/surgicalvitrectomy/
Outcomes
Retinopathy of Prematurity can be extremely progressive during the 28-40
weeks of vascularization. After the blood vessels are fully formed, the disease
becomes more stable. There is however a risk of further complications
developing later in life such as glaucoma and cataracts. There is also an
increased risk of developing strabismus and amblyopia along with acuity issues,
especially myopia.
Epidemiology
There are approximately 3.9
million infants born in the U.S.
each year. About 14,000 are
affected by ROP and 90% of those
affected have only mild disease.
About 1,100- 1,500 develop disease
severe enough to require medical
treatment and 400-600 infants each
year in the U.S. become legally
blind from ROP. (AAPOS, 2013)
Preformingsongwriter.com
Resources
• American Association for Pediatric Ophthalmology and Strabismus (July 2013). Retinopathy of Prematurity.
Retrieved from
http://www.aapos.org/terms/conditions/94
•
Griggs, Paul B. MD. (July 2013). Retinopathy of Prematurity. National Library of Medicine. MedlinePlus.
Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/001618.htm
• Hartnet, M. Elizabeth MD(November, December 2004). Managing Retinopathy of Prematurity. American
Academy of Ophthomology. EyeNet Magazine. Retrieved from
http://www.aao.org/publications/eyenet/200411/pearls.cfm
• Hartree, Niomi MD, Scott, Oliver MD (17/09/10). Retinopathy of Prematurity. Patient.co.uk. Retrieved from
http://www.patient.co.uk/doctor/Retinopathy-of-Prematurity-(Retrolental-Fibroplasia).htm
• Johnston, Suzan MD (2011). Retinopathy of Prematurity (ROP). Boston Children’s Hospital. Kids MD Health
Topics: Our Health Topics. Retrieved from
http://www.childrenshospital.org/health-topics/conditions/retinopathy-of-prematurity-rop
• National Eye Institute (June 2014) Facts about Retinopathy of Prematurity (ROP). Retrieved from
http://www.nei.nih.gov/health/rop/rop.asp
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