Like most terms that parents will hear in the NICU your first reaction to this term is what is that and what does it mean for my baby. Simply put ROP has to do with the vascularization, or blood supply to the retina in the eye. The retina is the light sensitive layer of tissue in the back of the eye that provides the message to our brain so that we can process what we are seeing. It is very important that the retina is supplied with blood so that it develops properly however in ROP too many vessels grow which can cause damage to the retina. Prior to 16 weeks gestation there is no blood supply to the retina. This vascularization begins to occur between 15 and 18 weeks gestation and continues to progress through the 40th week of gestation. In some cases the development of the blood supply to the retina is delayed all the way out to 48 or 52 weeks post-menstrual age. The cause of this condition is not well known however it is believed that certain factors such as a lack of oxygen, too much oxygen, and low blood pressure injures newly developing vessels or the formation of new vessels that will bring blood to the retina. All of the following factors may also play a role in ROP; low birth weight, low gestational age, assisted ventilation for longer than one week, surfactant therapy, high blood transfusion volume, cumulative illness severity, hyperglycemia, and insulin therapy.
One of the most confusing things I found during the report after an eye exam was the staging for ROP. You may hear the ophthalmologist spout off something like ROP stage II zone 3. The zone is the location of the retinopathy (see image below).
Image from Up To Date, http://www.uptodate.com/contents/retinopathy-of-prematurity?source=search_result&search=retinopathy+of+prematurity&selectedTitle=1%7E51
The stage indicates the severity of the disease with a stage 1 being an early stage and stage 5 being the most severe stage. In some situations the term Plus Disease will be used and this is typically an ominous sign for retinal detachment which can lead to blindness.
ROP will occur in approximately 68% of babies born that weigh less than 1251g or 2.78 pounds. In addition, gestational age at birth plays a role. Babies born earlier have a higher incidence of ROP.
The good news is that in the majority of cases ROP will totally resolve on its own. The ophthalmologist will perform serial exams about 2 weeks apart as long as there is nothing to warrant a weekly exam to monitor the progress of the disease. Here is a general rule of when follow-ups occur based on the severity of the disease.
Follow-up within one week is recommended for infants with
●Immature vascularization in zone I, without ROP
●Immature retina that extends into posterior zone II, near the boundary of zone I
●Stage 1 or 2 ROP in zone I
●Stage 3 ROP in zone II
●Suspected aggressive posterior ROP
Follow-up within one to two weeks is recommended for infants with:
●Immature vascularization in posterior zone II
●Stage 2 ROP in zone II
●Regressing ROP in zone I
Follow-up within two weeks is recommended for infants with:
●Stage 1 ROP in zone II
●Immature vascularization in zone II, without ROP
●Regressing ROP in zone II
Follow-up within two to three weeks is recommended for infants with:
●Stage 1 or 2 ROP in zone III
●Regressing ROP in zone III
If treatment becomes necessary it can be done with a procedure called photocoagulation in which a laser is used to destroy the extra vessels that have developed causing the condition. In some cases these extra blood vessels will strain the retina causing it to detach. For these cases a surgical procedure can be done.
No matter what degree of ROP your baby has it can and will be a scary time. It is always important to have a good communication with the nurses, doctors and practitioners so that you have a good understanding of what the diagnosis means for your baby. Never be shy to ask questions. Remember that understanding what your baby is going through is imperative to making the right choices for them.
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