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.

We believe that no child should start out life blind from an avoidable cause. With the right awareness, knowledge and equipment, retinopathy of prematurity is entirely preventable. Thanks to your support, our eye care teams are saving babies and infants from a lifetime of blindness.

At the fore, we're promoting the development of national retinopathy of prematurity protocols and guidelines. Other specific initiatives include:

Improving quality of premature infant care

We're helping improve standards of Neonatal Intensive Care Units (NICUs) through efficient delivery of oxygen therapy and ensuring universal screening for all babies at risk of the condition. We also work to improve the standards of ophthalmic facilities to diagnose, treat and follow up on premature infants.

Developing a training framework

We have developed a curriculum and training framework for NICU nurses and ophthalmologists. We're also providing training in laser and surgical treatment for eye care professionals to improve outcomes and avoid high complication rates.

Providing integrated care

By integrating neonatal and ophthalmic care, we're able to identify cases early and provide early timely treatment to prevent permanent blindness.

Technology for eye care

We are in the process of developing an app to track patient care and outcomes to provide timely feedback and evidence. This way, we can advocate for greater investment in care for this eye condition with hospital administrators and government.

Working with communities

At community level, we're prioritizing education and awareness for parents of children with retinopathy of prematurity, local healthcare providers and general practice physicians.