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Retinopathy of prematurity

Article Translations: (Spanish)

What is retinopathy of prematurity?

When a baby is born prematurely, the retina's blood vessels are still developing. The retina is the lining of the back of the eye, where images are formed and sent to the brain.

In most premature babies, the blood vessels develop as they should. Retinopathy of prematurity (re-tin-ah-path-ee of pree-mah-toor-ih-tee), also called ROP, occurs when the retina's blood vessels grow abnormally.

ROP starts slowly between 4 and 10 weeks after birth. Most mild forms of ROP heal by themselves. A small number of babies progress on to the most severe stages that can cause vision loss or even total blindness.

What causes ROP?

The cause of ROP is not completely known. It happens most often in the smallest, most premature babies, however, many other factors are also involved.

What are the signs of ROP?

There is no outward sign—the eyes will look normal even when severe ROP is present. It is hard to predict which babies' eyes will progress to more severe stages or which will heal.

All babies at risk for ROP need eye exams by an ophthalmologist (eye doctor) trained and experienced in examining premature babies' eyes. Beginning at 4 to 7 weeks of age, preemies at risk for ROP begin receiving eye exams every 1 to 2 weeks, until the blood vessels in the retina are fully developed (mature). Once the blood vessels are mature, there is no further risk for ROP.

The eye exams are carefully timed to follow the progress of the disease. If treatment is needed, it must be done at the right time for best results in your baby's eyes.

What is the treatment?

ROP progresses in stages from 1 (mild) to 5 (most severe). Treatment depends on the stage of ROP. The doctor will tell you the results of the exam and explain any needed treatment.

Stages 1 and 2 – Mild to moderate:

No treatment is needed. The abnormal retinal blood vessels will usually heal sometime in the first 4 months of life. Regular eye exams need to be continued until the blood vessels are fully mature.

Stage 3 – More severe:

The retinal blood vessels are more
abnormal. While healing may occur without treatment, often laser treatment or cryotherapy (freezing) is needed to try to prevent the disease from getting worse. Eye exams will be done more often, so any needed treatment can be done at the right time to decrease the risk of blindness.

Stages 4 and 5 – Most severe:

Scars develop in the retina and pull on it causing part or all of the retina to separate from the back of the eye. This is called a detached retina. It causes severe vision loss or blindness. Surgery may be done to try to reattach the retina and save some vision.

What do I need to do?

Your baby needs carefully timed eye exams, so treatment can be done at the right time. Important: If your baby goes home before the next scheduled ROP exam, staff will make an appointment for your baby in the eye doctor's office. Ask your nurse for the date and time of the appointment, and put it on your calendar.

Be sure to keep your baby's eye exam appointments. Missing ROP exams could result in blindness for your baby. Changes in the retina can develop very rapidly. If possible, do not change the appointment. If you must change it, call the eye doctor's office right away and tell the office scheduler that this is an ROP appointment, so it will be rescheduled as soon as possible.

Your baby will need eye drops before the exam to dilate (enlarge) the pupils (dark center of the eye). The eye doctor looks through this dark opening to carefully examine the retina.

___ If this is done in the doctor's office, the appointment will take about 1 hour.

___ If you are asked to give the eye drops, the appointment time will be shorter. Follow the directions on the label, starting 45 minutes before the appointment. See the education sheet, "Eye drops." The eye drops will make your baby's eyes sensitive to light. Cover them with a small towel or blanket when outside on the day of the exam.

What else do I need to know?

Some babies' pupils do not dilate easily, and more drops may be needed at the eye clinic.

Before the appointment, check with your insurance company about whether a referral from your baby's primary doctor is needed. Some insurance companies require pre-authorization or a referral for these clinic visits.

All premature babies, even those who don't have ROP or whose ROP is healed, have a higher risk of childhood eye problems such as strabismus (lazy eye) and needing glasses. Regular eye exams will be needed for their whole life.


This sheet is not specific to your child, but provides general information. If you have any questions, please call your baby's eye doctor.

Eye doctor's name

Phone number


Reviewed 8/2017

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit

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