Treatment of ROP

  • Information for Parents of Premature babies with more severe Retinopathy of Prematurity

    Severe retinopathy of prematurity (ROP) is rare but when it develops it can cause major vision problems. The chance of these vision problems developing can be minimised by appropriate treatment. This pamphlet is written to help you understand what is happening to your baby's eyes and what treatment may be needed. Remember severe ROP can be treated and vision saved.

    How do you know my baby has severe ROP?

    By now your baby has had one or more eye examinations by an ophthalmologist (medical eye specialist). At these examinations the development of the blood vessels in the retina has been checked. Your baby has been found to have abnormal blood vessels on the surface of the retina. This is known as "stage 3" ROP.

    Why did my baby develop severe ROP?

    The short answer is that we do not understand exactly why any one baby develops severe ROP. In general the sicker and smaller a baby is the more likely that baby is to develop severe ROP. Despite every effort made in giving premature babies the best care possible a small number still develop severe ROP.

    Why treat severe ROP?

    If severe ROP is untreated and progresses the retina will be either distorted or detached. Both of these problems can have a disastrous effect on vision and may result in a permanent reduction or loss of vision which cannot be later improved with operations or glasses, etc. The retina is like the film in a camera. If the film is damaged no matter what else is done to the camera it will always take poor quality pictures. Unfortunately the eye is not like a camera and it is not possible to put a new retina in to replace a damaged one.

    When is the best time to treat my baby's ROP?

    Treatment is recommended when severe stage 3 ROP is found. This is often called "threshold ROP". Once threshold ROP is found treatment is recommended within three days.

    What does treatment do?

    Successful treatment stops the development of abnormal blood vessels on the surface of the retina. This involves destroying a small area of retina next to the abnormal blood vessels. The controlled destruction of a small amount of retina stops the factors that stimulate the abnormal growth of blood vessels.

    What treatment is recommended?

    In most hospitals a type of laser treatment is now used for the treatment of threshold ROP. Treatment of the retina with a laser is known as "retinal photocoagulation". At the Royal Children's Hospital and the Royal Women's Hospital a "diode laser" is used.

    Laser is just a very intense light and the procedure by which the laser is applied to the eye is very similar to that used to examine the eye to detect the ROP is the first place. Laser treatment takes about 15 to 20 minutes for each eye.

    Does the laser treatment hurt my baby?

    No. The laser treatment is done with local anaesthetic and the procedure is well tolerated. Side effects from laser treatment for ROP are extremely rare. Cataracts have been reported as rarely occurring after this treatment.

    Is laser treatment safe in the long term?

    Laser treatment has been used for ROP since 1992 in Melbourne and no long term problems related to the laser treatment have been found. Laser treatment for retinal problems has been in use since the late 1960's and there have been very few reports of problems just due to the laser.

    What happens after the laser treatment?

    Anti-inflammatory steroid eye drops are often prescribed after laser treatment for about one week. Pain killers are seldom needed. Your baby's eyelids may be a little puffy after the treatment. This will settle within 24 hours.

    How will I know if the treatment is working?

    The eyes are rechecked between four and seven days after the treatment. You will be notified of the result of this examination as soon as possible. In most children there will be evidence of improvement in the ROP at this examination. Following successful laser treatment the ROP may take several weeks to disappear and the retinal blood vessels begin to grow normally.

    Will more than one laser treatment be needed?

    In a small number of cases re-treatment is needed between one and two weeks after the first treatment. Third treatments with laser are seldom needed.

    What happens if laser treatment doesn't work?

    This is unlikely to be the case. If laser treatment fails then the situation needs to be discussed with your paediatrician and ophthalmologist.

    Will my baby need more eye checks after laser treatment?

    Your baby will be checked regularly following laser treatment until the retinal blood vessels are fully developed. Following this the ophthalmologist will arrange to check your baby's eyes at regular intervals as she/he grows up. Even after successful treatment of ROP some children will need glasses for focusing problems and some children develop turned eyes.

    Who can I talk to about all of this?

    Your baby's paediatrician and the ophthalmologist are happy to discuss the management of your baby's ROP. Remember severe ROP can be treated and vision saved.