The membrane inside the eye (the retina) is not fully developed in a premature baby due to early birth. During the development of the foetus, the blood vessels grow from the central part of the eye outward, towards the edges. This process is completed just a few weeks before the normal time of delivery. In premature babies, this process is not complete due to their premature birth. After premature birth, if the blood vessel growth proceeds normally, the baby does not develop any problems. If the vessels grow and branch abnormally the baby develops a retinal problem called ROP (Retinopathy of Prematurity). It is most common in babies who are born more than 12 weeks prematurely. This abnormal growth of blood vessels can cause bleeding inside the eye and even progress to retinal detachment. The result is irreversible low vision or blindness.

A trained ophthalmologist (retina specialist) can detect ROP by dilating the eye (Dilating means instilling eye drops to make the pupil bigger to get a better view of the inside of the eye) and using an indirect ophthalmoscope to scan the entire retina to detect ROP and gauge the state of retinal maturity.

All preterm or premature babies must undergo a retinal examination. Babies with a birth weight of less than 1700 gm or those born less than 35 weeks of pregnancy are most likely to have ROP. Any other preterm baby who has had problems after birth (lack of oxygen/infection/blood transfusion/breathing trouble, etc.) is also vulnerable to ROP.

Follow the “Day 30” strategy. The first retinal examination should be completed before “Day 30” of the life of a premature baby. It should preferably be done earlier (i.e. within 2 to 3 weeks of birth) in very low-weight babies (i.e. those weighing less than 1200 gm birth weight). Follow-up examinations are COMPULSORY.

ROP can progress within 7 to 14 days and, therefore, needs a close follow-up (as advised by your doctor) till the retina matures.

ROP is treated with laser rays or a freezing treatment (cryopexy). The inner lining of the eye (retina) at the ends of these vessels is treated with lasers to seal the blood vessels and prevent further abnormal growth of the blood vessels. If left untreated the retina may get detached with further vision loss.

This decision is made by your retina doctor and will depend on what stage the disease is at. Stage 1 and Stage 2 do not usually need any treatment. These stages may resolve on their own without further progression. ROP needs to be treated as soon as it reaches a critical stage called threshold ROP. If the retina detaches then it becomes either Stage 4 or Stage 5 and in these cases, surgery is needed. Surgery for these stages has very poor visual outcomes. There is a 50% or greater risk of vision loss if left untreated after this. Hence, consistent follow-up checkups are necessary. Time is crucial!

Premature infants are more likely to need glasses in early childhood than children who are not premature. This may be the case even if your child did not have ROP, but it is more common in those with ROP. It is also possible to develop a “lazy” eye (amblyopia) or “wandering” eye (strabismus) and hence may require treatment for the same. Sometimes, they may need treatment for associated eye problems like cataracts, glaucoma, and retinal detachment.

It is of utmost importance to come for follow-up as specified by the eye doctor (Retina specialist). These examinations could save your child’s sight. Please don’t miss them!