Retinopathy of Prematurity (ROP) in Newborns: What Parents Need to Know

Retinopathy of Prematurity (ROP) is a serious condition affecting the vision of preterm newborns. Understanding this condition thoroughly—from its causes and symptoms to prevention and treatment—is extremely important to protect your baby's vision. If not detected and treated promptly, ROP can lead to permanent blindness [1].

1. What You Should Know About ROP

What is ROP?

ROP is a retinal vascular disease that occurs in premature infants, particularly those with low birth weight and young gestational age [1]. This condition is characterized by the abnormal development of blood vessels in the retina—the light-sensitive tissue layer at the back of the eye [2].

Who is at Risk for ROP?

The main risk factors for ROP include:

Low gestational age: Infants born before 30 weeks of gestation are at the highest risk [2, 5].
Low birth weight: Infants weighing less than 1,500 grams are at high risk [1, 2, 5].
Oxygen therapy: Oxygen administration, especially when oxygen levels fluctuate or are too high, can affect retinal blood vessel development [1, 5].
Other health issues: Sepsis, intraventricular hemorrhage (IVH), blood transfusions, and poor postnatal weight gain are also important risk factors [1, 5].

2. Causes of Retinopathy of Prematurity

Interruption of Retinal Vascular Development

During normal intrauterine development, retinal blood vessels begin to form around the 16th week and complete by about the 40th week of gestation [1, 2]. When an infant is born prematurely, this process is interrupted, leaving peripheral retinal areas inadequately vascularized [1].

3. Diagnosis of ROP

Diagnosing ROP requires regular and thorough screening by an experienced pediatric ophthalmologist, especially in high-risk infants [1, 2].

Screening Criteria

According to the guidelines of the Ministry of Health of Vietnam (Decision No. 1740/QĐ-BYT, dated June 19, 2024), newborns need ROP screening if:

All infants with a gestational age at birth ≤ 33 weeks and/or a birth weight ≤ 1,800 grams.
Infants with a gestational age at birth > 33 to 34 weeks and/or a birth weight > 1,800 to 2,000 grams, but with additional risk factors such as respiratory distress, pneumonia, anemia, infection, etc., must also undergo eye examinations upon physician request.

Timing of Screening

The first screening examination is typically performed when:

For infants with a gestational age at birth ≤27 weeks: examine when the infant reaches 31 weeks of postmenstrual age (combining gestational age and chronological age).
For infants with a gestational age at birth > 27 weeks: examine 3 to 4 weeks after birth.

Examination Methods

Indirect Ophthalmoscopy: This is the gold standard for diagnosing ROP. The physician will administer dilating eye drops, then use an indirect ophthalmoscope with a scleral depressor to examine the entire retina [1, 2].
Wide-Field Digital Retinal Imaging (RetCam): Increasingly used to capture retinal images, assisting in diagnosis, monitoring, and teleconsultation [1].

4. Treatment Methods for ROP

Not all cases of ROP require treatment. Many mild cases (stages 1 and 2) can regress spontaneously without intervention [1, 2]. However, if the disease progresses severely (especially stage 3 ROP with Plus signs or AP-ROP), prompt treatment is necessary to protect vision [1, 2].

Monitoring and Observation

For stage 1 or 2 ROP without Plus signs, physicians typically closely monitor the infant's eye condition every one to two weeks until retinal blood vessels are fully developed or the disease spontaneously regresses [1].

Interventional Treatment

Treatment options depend on the stage and clinical condition of the infant, including:

Laser photocoagulation
Intravitreal anti-VEGF injection
Surgery

5. Complications of ROP

ROP can lead to multiple serious complications affecting an infant's vision and quality of life [1].

Ophthalmic Complications

Retinal Detachment: This is the most common and serious complication of ROP, which can lead to permanent vision loss if not treated promptly [1].
Foveal Hypoplasia and Amblyopia: Incomplete development of the fovea (the region responsible for sharp vision) and visual imbalance can cause amblyopia, requiring early treatment to maximize vision [1].
High Refractive Errors: Infants with ROP are at high risk for severe myopia, astigmatism, or hyperopia [1].
Strabismus and Nystagmus: Retinal developmental disorders can lead to strabismus (misaligned eyes) and nystagmus (involuntary eye movements) [1].
Glaucoma: May develop due to anterior chamber angle abnormalities or fibrovascular membrane formation, leading to increased intraocular pressure and optic nerve damage [1].
Cataracts: May occur as a result of intravitreal injections or surgical interventions [1].
Vitreous Hemorrhage: Fragile new blood vessels can spontaneously bleed, causing sudden vision loss [1].
Phthisis Bulbi: In severe end-stage ROP cases, the eye may shrink and lose function [1].

Long-Term Impact

Survivors of ROP, particularly those who have undergone treatment, require lifelong ophthalmologic follow-up. Late complications such as retinal tears, refractive changes, amblyopia, and strabismus can develop over time [1]. Children who are blind or visually impaired due to ROP may also face developmental, educational, and social challenges [1].

6. Parent and Caregiver Education

Understanding ROP and Risks: Explain to parents that ROP is an issue of eye blood vessel development, influenced by oxygen levels, nutrition, and the infant's overall health. Emphasize that premature infants with low birth weight ($<1,500$g or $<32$ weeks of gestational age) are at the highest risk and require specialized eye care [1].
Importance of Timely Screening and Follow-up: Stress the necessity of adhering to recommended screening schedules, including the first exam according to the aforementioned screening criteria, followed by follow-up exams every 1 to 2 weeks until the retina is fully vascularized [1].
Signs to Monitor: Guide parents to recognize warning signs such as abnormal eye movements, a "white pupil" reflex in photographs, or red eyes. Although these are typically late indicators, they do not replace scheduled examinations [1].

7. When to Seek Immediate Eye Specialist Care

If your premature infant exhibits any of the following signs, take them to see an eye specialist immediately [2]:

Warning Signs to Watch For

The baby's eyes show abnormal movements, shaking, or inability to track objects.
The baby's pupils appear white when looked at (leukocoria).
The eyes show signs of redness, swelling, or abnormal discharge.
The infant appears to have difficulty seeing or reacting to light.

8. Importance of Regular Examinations

Even if there are no clear symptoms, adhering to the scheduled regular ROP screening intervals directed by your physician is extremely important. Early detection and treatment of ROP is the best way to minimize the risk of serious complications and protect your child's vision [2].

9. Frequently Asked Questions

Is ROP hereditary? ROP is primarily caused by environmental factors related to prematurity, but some studies suggest genetic factors may contribute to susceptibility [1]. However, it is not a direct Mendelian inherited genetic disorder [1].
Can ROP resolve on its own? Yes, many mild cases of ROP (stages 1 and 2) can spontaneously regress without treatment and without affecting the child's vision [1, 2].
Can newborns with ROP see clearly? If ROP is detected and treated promptly in the early stages, many children can develop normal or near-normal vision [1]. However, in severe cases or when complications arise, children may suffer permanent visual impairment or blindness [1, 2].

10. References

[1] Kaur, K., & Mikes, B. A. (2025). Retinopathy of Prematurity. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK562319/. Accessed: 2025-12-14.
[2] National Eye Institute. (2025). Retinopathy of Prematurity. National Eye Institute - NIH. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinopathy-prematurity. Accessed: 2025-12-14.
[3] Sobhy, M., Cole, E., Jabbehdari, S., Valikodath, N. G., Al-Khaled, T., Kalinoski, L., Chervinko, M., Chuluunkhuu, C., Shah, P. K., KC, S., Jonas, K. E., Scanzera, A., Yeh, S., Kalpathy-Cramer, J., Chiang, M. F., Campbell, J. P., & Chan, R. V. P. (2022). Operationalization of Retinopathy of Prematurity Screening by the Application of the Essential Public Health Services Framework. International Ophthalmology Clinics, 63(1), 39–63. https://pmc.ncbi.nlm.nih.gov/articles/PMC9839316/. Accessed: 2025-12-14.
[4] Hong, E. H., Shin, Y. U., & Cho, H. (2022). Retinopathy of prematurity: a review of epidemiology and current treatment strategies. Clinical and Experimental Pediatrics, 65(3), 115–126. https://pmc.ncbi.nlm.nih.gov/articles/PMC8898617/. Accessed: 2025-12-14.
[5] Kim, S. J., Port, A. D., Swan, R., Campbell, J. P., Chan, R. V. P., & Chiang, M. F. (2018). Retinopathy of Prematurity: A Review of Risk Factors and their Clinical Significance. Survey of Ophthalmology, 63(5), 618–637. https://pmc.ncbi.nlm.nih.gov/articles/PMC6089661/. Accessed: 2025-12-14.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.