Retinopathy of prematurity

What is retinopathy of prematurity?

Retinopathy of prematurity is a condition that can affect babies who are born early, before the blood vessels that supply the light-sensitive layer of the eye (the retina) have finished growing. In this condition, the retinal blood vessels grow in a disorganised way after the baby is born.

This can lead to bleeding and scarring that can pull the retina away from the wall of the eye (retinal detachment). If it’s not treated, retinopathy of prematurity can cause irreversible sight loss.

What causes retinopathy of prematurity?

Premature babies that have a low birth weight (less than 1.5kg or 3lbs 5oz) or are born at 32 weeks or less, are most at risk of retinopathy of prematurity. The lower the birth weight, the bigger the risk. High levels of oxygen necessary to support premature babies can also increase the risk of retinopathy of prematurity.

What are the signs and symptoms of retinopathy of prematurity?

There won't be any visible signs that your baby has retinopathy of prematurity, which is why an eye test is given to babies at risk. If your child's sight is damaged, you may later notice that their pupils look white, or they have trouble recognising faces or don't follow objects with their eyes. 

Retinopathy of prematurity is classed into five stages. These range from very mild to very severe. Most babies will have stage 1 or stage 2 and will go on to have normal vision. The more severe stages can lead to severe sight impairment.

• Stage one: Blood vessel growth is mildly abnormal. Babies usually recover without any medical treatment.
• Stage two: Blood vessel growth is moderately abnormal. Babies usually recover without any medical treatment in this stage as well.
• Stage three: Blood vessel growth is severely abnormal. Treatment may be required at this stage.
• Stage four: Partial retinal detachment occurs which means the retina is pulling away from the back of the eye.
• Stage five: Retinal detachment occurs, which means the retina has fully detached from the back of the eye. This leads to permanent loss of vision.

Is retinopathy of prematurity serious?

It depends on what stage the condition is. Stages one and two are usually not very serious. In stages three to five, if retinopathy of prematurity is not treated, it can cause irreversible sight loss. It is a leading cause of childhood blindness worldwide.

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How is retinopathy of prematurity diagnosed?

Retinopathy of prematurity is diagnosed by a screening eye examination given to all premature babies at risk of the condition. It is done by an ophthalmologist or other specially trained health professional, using an ophthalmoscope or a camera.

What are the treatments for retinopathy of prematurity?

Some babies will not require any treatment as the issue will resolve itself. If treatment is required then it is usually treated by laser therapy or freezing treatment (cryotherapy) - these treatments target specific parts of the retina to stop the growth of abnormal blood vessels.

Some cases are now treated with injections, which are used alongside laser therapy, to aid in stopping the growth of abnormal blood vessels. Early treatment is very successful at preventing severe sight loss in most cases.

What research is there into retinopathy of prematurity?

In 1953, Fight for Sight founder Norman Ashton discovered the link between retinopathy of prematurity and oxygen given to babies in the incubator. His research led to controlled oxygen delivery and has saved the sight of countless babies.

However, there is still a lot of work to do to improve treatments for retinopathy of prematurity and to prevent sight loss from developing.

Fight for Sight's Research Strategy has pledged to spend over 20 million on pioneering eye research over the next five years. If your family is affected by retinopathy of prematurity and are interested in fundraising to help us fund cutting-edge research in this area, find out how to set up a family fund.

Personal stories of retinopathy of prematurity

In 2012 Sienna Parsi and her brother, Joshua, were born premature at 28 weeks and 6 days to parents Catherine and Mehdy. They spent 50 days in a special care unit. In the week of discharge from hospital, they found out that Sienna, who had been born weighing 2lb 6oz (1.1kg), had retinopathy of prematurity.

Catherine said: “Given the diagnosis that Sienna may never be able to see and that she would be lucky to have navigation vision and light perception was very hard to come to terms with, as Sienna’s mum but also as a family because I think you take your sight for granted.

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