Retinopathy of Prematurity: Causes, Symptoms and Treatment

Read below to find out more about this blinding condition and discover what our teams are doing to help combat retinopathy of prematurity and help babies see the world around them.

Babies born at a very early gestation can develop retinopathy of prematurity where blood vessels grow abnormally and uncontrollably causing damage to the light sensitive layer of the retina.

In the worst case scenario this can lead to bleeding and scarring that can pull the retina away from the wall of the eye (retinal detachment) putting the baby at risk of becoming blind.

According to the World Health Organization 15 million babies are estimated to be born early each year and with pre-term birth comes the risk of blindness. The International Agency for the Prevention of Blindness tell us that 32,300 pre-term babies become permanently blind or visually impaired from retinopathy of prematurity every year.

Retinopathy of prematurity is also known as retrolental fibroplasia or Terry syndrome.

According to International Agency of the Prevention of Blindness risk factors of retinopathy of prematurity include:

• Low birth weight (less than 1,500g) - the smaller the baby, the greater the risk
• Babies born at 32 weeks gestation or less
• Oxygen levels (which are highly toxic to blood vessels) too high during neonatal treatment
• Sepsis
• Chronic Lung Disease
• Poor nutrition

Severe and untreated retinopathy of prematurity can present some of the following symptoms:

• White pupils, called leukocoria
• Abnormal eye movements, called nystagmus
• Crossed eyes, called strabismus
• Severe nearsightedness, called myopia

Retinopathy of prematurity is classed into five stages ranging from very mild to very severe progression. Most babies with stage 1 or stage 2 will need no intervention and live with normal vision.

However, the more severe stages can lead to severely impaired vision.

Stage 1

Blood vessel growth is mildly abnormal but babies usually recover without any medical treatment.

Stage 2

Blood vessel growth is moderately abnormal. Babies usually recover without any medical treatment.

Stage 3

Blood vessel growth is severely abnormal and treatment may be required.

Stage 4

Partial retinal detachment takes place which means the retina is pulling away from the back of the eye.

Stage 5

Retinal detachment occurs, which means the retina has fully detached from the back of the eye leading to irreversible vision loss.

Preventing pre-term birth

Preventing premature births will reduce the incidence of babies developing retinopathy of prematurity.

Early detection

Having specialist ophthalmologists carefully monitoring and examining at-risk babies during the weeks after birth and before hospital discharge. The only way to determine if babies are at risk is to examine the inside of their eyes for abnormalities in the retina.

A pediatric ophthalmologist can detect changes in a baby's retina through proper examination using special instruments.

Delivery of neonatal care

Providing better resources and equipment in low-to-middle income countries to manage the care of babies in neonatal units - especially in relation to monitoring the oxygen levels a pre-term baby is exposed to after birth. High levels of oxygen are damaging to blood vessels and linked to development of retinopathy of prematurity.

Laser therapy or freezing treatment (cryotherapy)

This kind of therapy is used for treating advanced stages and targets specific parts of the retina to stop the growth of abnormal blood vessels. Some cases are now treated with injections, which is used alongside laser therapy to stop the growth of abnormal blood vessels.

Long-term follow up

Children born pre-term have a greater risk of refractive errors and strabismus, and may have visual impairment so following up allows detection of further eye conditions caused by retinopathy of prematurity.

At Orbis, we're implementing a comprehensive approach to improve eye care for babies and infants impacted by retinopathy of prematurity. 

Training: We provide advanced training and mentorship to eye care teams in nearly every country in the world, empowering them to deliver sight-saving care where the need is greatest. Our specialist training is delivered in partnership with local hospitals, public health agencies and governments. It takes place on board our incredible Flying Eye Hospital, through our online mentoring platform, Cybersight, and through our long-term country programs. 

Technology: Through innovative technology like our award-winning telemedicine platform Cybersight, artificial intelligence diagnostic technology, virtual reality training, and the world’s first and only Flying Eye Hospital, we're revolutionizing ophthalmic training for eye care professionals and treatment for patients around the world.

Treatment and prevention: Through our long-term country programs we provide equitable access to quality eye care that transforms lives and communities. Orbis puts eye care within reach through programs that serve communities where they are. To reach the most underserved populations, quality care must be not only available, but also easily accessible. 

Teamwork: Through support from donors, corporate sponsors, employees, governments, and a team of more than 400 world-renowned medical volunteers, we work in collaboration with local partners to improve the quality and availability of eye care, ensuring our impact endures long term and becomes self-sustaining.