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