Retinopathy of Prematurity (ROP) is an impairment of a baby’s retina, the light-sensitive inner layer of the eye, because of the abnormal growth of blood vessels. In its early stages, ROP can be self-limiting. However, in cases where blood vessel grwoth does not stop, it may be necessary for an eye specialist to intervene and save vision.

To identify the early indications of ROP, doctors follow the 30-day strategy:

• The first eye examination (dilated retinal examination) must be done before the baby’s 30^th day of life
• In extremely low birth weight babies (<1200 grams), the eye examination should ideally happen sooner (around 2-3 weeks of birth)

Remember, tees din roshni ke! (thirty days to vision!)

There are no signs or symptoms that are visible to the parents. Although a premature baby’s eyes may look normal, the retina inside may not be fully developed. ROP progresses silently. Only a trained ophthalmologist can diagnose ROP by performing a detailed retinal examination.

Many retinal diseases are silent in the early stages. Prompt screenings, especially for at-risk individuals, is critical.

The retina of the baby develops over the full 9 months of pregnancy. When a baby is born prematurely, the blood vessels in the retina (the light-sensitive part at the back of the eye) are not fully developed. After birth, these vessels may grow abnormally, which can lead to scarring, bleeding, or even retinal detachment (a serious condition that can cause vision loss).

When a child is born preterm, their retina is not fully vascularized (rich in blood vessels). After 20-30 days in the newborn intensive care unit (NICU), these babies are taken out of their oxygen-rich incubators, which causes an oxygen demand in the eye, resulting in an abnormal growth of retinal blood vessels. That is why every preterm baby should be screened for ROP within the first 30 days of their life. During this screening, a specialist can identify early indications of ROP and treat it with a higher chance of success.

Risk factors for ROP

• Preterm birth and unblended or 100% pure oxygen (during NICU stay)
• Baby’s poor weight gain
• Pregnant mothers who are malnourished
• Geriatric pregnancy
• Anemic mother, or child.

All these factors, and more, can trigger Retinopathy of Prematurity (ROP) in a baby’s eyes.

To stop abnormal vessel growth, prevent a retinal detachment, and preserve vision, ROP is treated with:

• Laser: A special light is used to destroy harmful, new and irregular blood vessels from growing. This protects the baby’s sight and prevents the problem from getting worse.
• Anti-VEGF injections (depending on the stage of ROP): When injected into the baby’s eye, the medicine blocks signals that cause abnormal blood vessel growth and helps control the disease.
• Cryopexy (freezing treatment): Here, cold therapy is used to freeze certain parts of the eye, helping stop unwanted blood vessels from developing further.

In advanced stages of ROP, vitreoretinal surgery and vision rehabilitation are suggested.

After treatment, the baby:

• is expected to have reasonably good vision.
• needs to have eye examinations until they start going to school.
• may need glasses
• may require further treatment for lazy eyes / cross-eyes and, sometimes for cataract, glaucoma, retinal detachment.