RETINOPATHY OF PREMATURITY (ROP)

What is ROP?

ROP stands for Retinopathy of Prematurity. It is a disorder of retinal blood-vessel development that can occur in premature babies. In severe cases, it can cause retinal detachment and blindness.

Does every premature baby develop ROP?

No. Only some premature or high-risk babies develop ROP. However, babies who meet screening criteria should undergo retinal examination even if their eyes appear normal.

Can parents identify ROP at home?

Usually, no. Early ROP generally has no obvious symptoms. A baby may appear to see normally even when significant retinal disease is developing. This is why scheduled ROP screening is so important.

When should my premature baby be screened first?

Do not wait for a problem to appear before arranging an ROP examination.

• Most eligible babies: First ROP examination at about 4 weeks postnatal age (PNA).
• Very premature / very low-birth-weight babies: Babies born at <28 weeks gestation OR with birth weight <1200 g should have an earlier first examination at 2–3 weeks of life.
• Practical timing: For eligible babies, the first ROP examination should be completed within the first 4 weeks of life; smaller/more premature babies require screening earlier.

Is ROP screening painful?

The examination may cause temporary discomfort or irritability because the baby's pupils need to be dilated and the retina needs to be examined carefully. Appropriate measures are taken to make the examination as safe and comfortable as possible.

If the first examination is normal, is further screening necessary?

Sometimes, yes. Retinal blood vessels continue to develop after birth, and ROP can appear or progress later. Your ophthalmologist will tell you when the next examination is required.

Does every baby with ROP need laser treatment?

No. Many babies with mild ROP improve naturally with observation. Treatment is recommended only when the disease reaches a level where the risk of vision-threatening progression is significant.

What is laser treatment for ROP?

Laser treatment targets the peripheral retina where blood vessels have not developed normally. It reduces the stimulus for abnormal blood-vessel growth and helps prevent progression to retinal detachment.

What is an anti-VEGF injection?

Anti-VEGF medicines can reduce abnormal blood-vessel activity in the retina. They may be used in selected cases of severe or posterior ROP. Because ROP can recur after anti-VEGF treatment, long-term and careful follow-up is essential.

Can ROP cause permanent blindness?

Severe untreated ROP can cause retinal detachment and permanent blindness. The good news is that early screening and timely treatment can prevent many cases of severe visual loss.

Does a baby need follow-up after successful ROP treatment?

Yes. Even after ROP has regressed, premature children can have a higher risk of refractive errors, squint, amblyopia and other visual problems. Long-term eye examinations are therefore important.

My baby was premature but is now home and doing well. Does the baby still need ROP screening?

Yes, if the baby meets the criteria for ROP screening. Being discharged from the NICU does not automatically mean that the risk of ROP has passed.

Can ROP be completely prevented?

The risk can be reduced through good neonatal care and appropriate management of premature babies, but ROP cannot always be prevented. The most important step for parents is timely screening and ensuring that no scheduled follow-up examination is missed.

Suggested Parent-Facing Wording

"ROP screening is recommended for premature and low-birth-weight babies, including babies born at ≤34 weeks or with birth weight ≤2000 g, with earlier screening for very premature or very low-birth-weight babies. We also provide bedside ROP screening in the NICU so that eligible babies can be examined at the appropriate time."

Guideline Basis

• Indian operational guidance: Broad screening eligibility includes gestational age ≤34 weeks and/or birth weight ≤2000 g, with additional screening of larger/more mature infants with risk factors.
• NNF guidance: First screening is recommended at 4 weeks postnatal age, with earlier screening for very premature/very low-birth-weight infants.

A Message for Parents

ROP can progress silently—but timely screening can save vision.

If your baby was born prematurely or had a low birth weight, ask your neonatologist or paediatrician whether an ROP screening examination is required.

Do not wait for your baby to develop symptoms. Early examination, timely treatment and regular follow-up are the keys to protecting your baby's vision.