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Before 1960, it was rare to see infants live if they were born prematurely at less than 30 weeks gestational age (full term is 37 to 41 weeks’ gestation) or were born weighing less than 1500 g (3 lbs 5 oz). With advances in medical care, it is now common to see these infants survive. Unfortunately, some of the infants who live may develop complications. One complication is retinopathy of prematurity (ROP), which usually resolves without long term complications but in the worst form may lead to blindness.
Retinopathy is a disorder affecting the part of the back of the eye called the retina, which responds to light much like the film in a camera. ROP is a condition that occurs in premature infants younger than 30 weeks at birth or in those infants who weigh less than 1500 g at birth. These infants are usually very sick and need intensive medical care to live.
ROP occurs because blood vessels in the retina of premature infants are not fully developed at birth and can be damaged by a high amount of oxygen in the baby’s blood, a situation that can occur even with very careful monitoring. As the affected blood vessels grow, they may do so in an irregular manner that often corrects itself but occasionally may cause bleeding and scarring. The worst form of ROP causes the retina to tear away from the back of the eye, perhaps causing blindness or very poor vision.
Generally, ROP starts as early as five to six weeks of age and may become worse until seven to 17 weeks after birth. Eye doctors or opthamologists begin examining the eyes of premature infants at four to six weeks of age and then usually every two to four weeks after that to find those who are most likely to develop serious visual problems. There is effective treatment to reduce the chance of blindness from ROP, but early diagnosis is essential. Because the eyes of these infants are not easy to examine, considerable skill is required to identify ROP. Ophthalmologists are the best qualified to examine the eyes of these infants.
Surgery for ROP can save the vision of about 50% of infants who would otherwise become blind. The surgery, using a special technique, works by sticking the retina to the back of the eye much like glue sticks paper together.
Most infants born in Canada who are very premature or who have a very low birth weight are monitored closely by doctors and nurses specializing in the problems of premature children. As part of this follow-up, eye examinations for all infants with ROP should be completed at one and four years of age to detect error of refraction, squint and general use of the eyes. For those with more severe forms of ROP, eye examinations may need to be completed more often. Although serious problems may occur with the vision of premature infants, early eye examinations in the nursery and proper treatment usually mean a good outcome.
Parents who have other questions regarding ROP should discuss the matter with a neonatologist or ophthalmologist.
This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.
This information may be reproduced without permission and shared with patients and their families. (Reviewed by the Canadian Paediatric Society Board of Directors.)
Canadian Paediatric Society, 2204 Walkley Road, Suite 100, Ottawa, Ontario K1G 4G8 telephone 613-526-9397, fax 613-526-3332, http://www.cps.ca