Learn About Retinopathy of Prematurity
Retinopathy of prematurity (ROP) is abnormal blood vessel development in the retina of the eye in infants that are born too early (premature).
Retrolental fibroplasia; ROP
The blood vessels of the retina (in the back of the eye) begin to develop about 3 months into pregnancy. In most cases, they are fully developed at the time of normal birth. The eyes may not develop properly if a baby is born very early. The vessels may stop growing or grow abnormally from the retina into the back of the eye. Because the vessels are fragile, they can leak and cause bleeding in the eye.
Scar tissue may develop and pull the retina loose from the inner surface of the eye (retinal detachment). In severe cases, this can result in vision loss.
In the past, the use of too much oxygen in treating premature babies caused vessels to grow abnormally. Better methods are now available for monitoring oxygen. As a result, the problem has become less common, especially in developed countries. However, there is still uncertainty about the right level of oxygen for premature babies at different ages. Researchers are studying other factors besides oxygen which appear to influence the risk of ROP.
Today, the risk of developing ROP depends on the degree of prematurity. Smaller babies with more medical problems are at higher risk.
Almost all babies who are born before 30 weeks or weigh less than 3 pounds (1360 grams or 1.36 kilograms) at birth are screened for the condition. Some high-risk babies who weigh 3 to 4.5 pounds (1.36 to 2.04 kilograms) or who are born after 30 weeks should also be screened.
In addition to prematurity, other risk factors may include:
- Brief stop in breathing (apnea)
- Heart disease
- High carbon dioxide (CO2) level in the blood
- Infection
- Low blood acidity (pH)
- Low blood oxygen
- Respiratory distress
- Slow heart rate (bradycardia)
- Transfusions
The rate of ROP in most premature infants has gone down greatly in developed countries over the past few decades due to better care in the neonatal intensive care unit (NICU). However, more babies born very early are now able to survive, and these very premature infants are at the highest risk for ROP.
The blood vessel changes cannot be seen with the naked eye. An eye exam by an ophthalmologist is needed to reveal such problems.
There are five stages of ROP:
- Stage I: There is mildly abnormal blood vessel growth.
- Stage II: Blood vessel growth is moderately abnormal.
- Stage III: Blood vessel growth is severely abnormal.
- Stage IV: Blood vessel growth is severely abnormal and there is a partially detached retina.
- Stage V: There is a total retinal detachment.
An infant with ROP may also be classified as having "plus disease" if the abnormal blood vessels match pictures used to diagnose the condition.
Symptoms of severe ROP include:
- Abnormal eye movements
- Crossed eyes
- Severe nearsightedness
- White-looking pupils (leukocoria)
Early treatment has been shown to improve a baby's chances for normal vision. Treatment should start within 72 hours of the eye exam.
Some babies with "plus disease" need immediate treatment.
- Laser therapy (photocoagulation) may be used to prevent complications of advanced ROP.
- The laser stops the abnormal blood vessels from growing.
- The treatment can be done in the nursery using portable equipment. To work well, it must be done before the retina develops scarring or detaches from the rest of the eye.
- Other treatments, such as injecting an antibody that blocks VEG-F (a blood vessel growth factor) into the eye, are still being studied.
Surgery is needed if the retina detaches. Surgery does not always result in good vision.
Cynthia Toth is an Ophthalmologist in Durham, North Carolina. Dr. Toth is rated as an Elite provider by MediFind in the treatment of Retinopathy of Prematurity. Her top areas of expertise are Retinopathy of Prematurity, Age-Related Macular Degeneration (ARMD), Late-Onset Retinal Degeneration, Vitrectomy, and Trabeculectomy. Dr. Toth is currently accepting new patients.
Duke Eye Center
I was born and raised right here in Durham, NC. After attending college at Duke, I ventured north to Boston, where I completed most of my medical training, and was fortunate to meet and marry the love of my life, my husband Neil (also on faculty as a cardiologist here at Duke). I returned to Durham for my Glaucoma fellowship, briefly joined the faculty “across the street” at UNC-Chapel Hill, and then returned “home” to Duke Eye Center in 1995, where I have been on the faculty ever since. Dual fellowship-trained in both Pediatric Ophthalmology and Strabismus as well as in Glaucoma, I have a clinical and research focus on pediatric glaucoma and cataracts, as well as retinopathy of prematurity, but enjoy providing care for myriad pediatric problems of the eyes, including treatment of “grown children” with ocular alignment issues. My modus operandi is very simple – I simply try hard to treat each and every patient the way I would like someone to treat me. It works every time, and I am privileged to be a clinician and educator at Duke Eye Center and in Duke University Health System. Dr. Freedman is rated as an Elite provider by MediFind in the treatment of Retinopathy of Prematurity. Her top areas of expertise are Retinopathy of Prematurity, Strabismus, Brown Syndrome, Trabeculectomy, and Cataract Removal.
Chicago Arbor Eye Institute
Michael Blair is an Ophthalmologist in Chicago, Illinois. Dr. Blair is rated as an Elite provider by MediFind in the treatment of Retinopathy of Prematurity. His top areas of expertise are Retinal Detachment, Stickler Syndrome, Retinopathy of Prematurity, Diabetic Retinopathy, and Vitrectomy.
Most infants with severe vision loss related to ROP have other problems related to early birth. They may need many different treatments.
About 1 out of 10 infants with early changes will develop more severe retinal disease. Severe ROP may lead to major vision problems or blindness. The key factor in the outcome is early detection and treatment.
Complications may include severe nearsightedness or blindness.
The best way to prevent this condition is to take steps to avoid premature birth. Preventing other problems of prematurity may also help prevent ROP.
Summary: This is an observational study in which only data from babies with retinopathy of prematurity (ROP) who are being treated with aflibercept (Eylea) in prefilled syringe (PFS) using a paediatric dosing device (PDD) are collected and studied. ROP is a condition that affects the eyes of preterm babies. It occurs when the baby's retina, the part of the eye that senses light, does not develop normally. ...
Summary: This is an observational study to collect data from Japanese babies with retinopathy of prematurity (ROP) who will be treated with Eylea. In observational studies, only observations are made without specified advice or interventions. ROP is a condition that affects the eye and occurs only in babies who are born too early. Most cases of ROP are mild and get better without treatment, but more seriou...
Published Date: April 06, 2025
Published By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Sun Y, Hellström A, Smith LEH. Retinopathy of prematurity. In: Martin RJ, Fanaroff AA, eds. Fanaroff and Martin's Neonatal-Perinatal Medicine. 12th ed. Philadelphia, PA: Elsevier; 2025:chap 100.
Thanos A, Drenser KA, Capone A Jr. Retinopathy of prematurity. In: Yanoff M, Duker JS, eds. Ophthalmology. 6th ed. Philadelphia, PA: Elsevier; 2023:chap 6.17.