Retinopathy of Prematurity FAQs

I. What Is Retinopathy of Prematurity?

Retinopathy of prematurity (ROP) is a disease that develops in the eyes of some premature infants. It is potentially blinding.

The retina is the layer of tissue at the back of the eye that is light sensitive. It works like the film in a camera, receiving light that forms images and comes into the eye through the pupil and the lens. The images are converted into electric signals that are sent to the brain through the optic nerve.

When a baby is born prematurely, the blood vessels of the retina have not finished developing. The retinal blood vessels in the baby born at term finish developing around the time that the baby is born or soon after. When this development of blood vessels is interrupted by the premature birth of the infant, the vessels stop growing or begin to grow abnormally, extending into the clear gel of the inside of the eye.

The blood vessels are fragile, break easily and bleed into the eye. They form scars that shrink with time and pull the retina away from the inner wall of the eye. If the retina completely detaches from the eye wall, the child becomes blind.

II. What Are the Retinopathy of Prematurity Statistics in Infants?

Because of advances in neonatal care and technology, smaller more premature babies are being born every year. This growth in the number of premature babies being saved increases the number of those born with retinopathy of prematurity (ROP). However, not all babies born prematurely have ROP. The degree of prematurity determines an infant’s risk of developing ROP.

Those at highest risk in general are the smallest and sickest premature infants.

  • About 3.9 million children are born annually in the U.S.
  • Some 28,000 weigh 2 ¾ pounds or less.
  • Between 14,000 and 16,000 of these premature infants are born each year with some degree of retinopathy of prematurity.
  • About 90 percent of them are born with a mild form of the disease and they have no lasting damage. Infants with a more severe form of ROP, however, can develop impaired vision or become blind.
  • Each year, from 1,100 to 1,500 infants develop ROP that needs to be treated.
  • Between 400 and 600 of those infants become legally blind.

It is usual to screen for ROP all babies younger than 30 weeks gestation or those weighing less than three pounds when they are born. Sometimes, certain infants who are at higher risk for retinopathy of prematurity, even though they weigh more than three pounds or are born after 30 weeks gestation, also should be screened for the disease.

III. How Many Stages are there of Retinopathy of Prematurity?

There are five stages of ROP classified according to the severity of the disease:

  • Stage I: Babies with this stage of ROP have only mild ROP with minimum growth of blood vessels into the eye. Many children at this stage of the disease improve without treatment.
  • Stage II: Many children with stage II disease get better on their own without treatment. There is moderately abnormal blood vessel growth at this stage.
  • Stage III: Infants with stage III disease have blood vessel growth that is seriously abnormal. Instead of growing normally along the surface of the retina, blood vessels grow toward the center of the eye. Although some with stage III disease will eventually have normal vision without treatment, many babies, especially those with enlarged and twisted blood vessels (called plus disease) require treatment. These enlarged and twisted blood vessels indicate that the disease is growing worse. Treatment of babies with stage III disease usually prevents retinal detachment.
  • Stage IV: Babies with this stage of the disease have a partially detached retina. Scars result from bleeding of the fragile abnormal blood vessels. When the scars contract, they pull the retinal tissue away from the wall of the eye.
  • Stage V: At this stage, infants have a totally detached retina that without treatment will lead to blindness.

IV. Can There be Other Health Complications from ROP?

Infants with severe retinopathy of prematurity can become extremely nearsighted or blind. Their risk is higher of having retinal detachment, strabismus (crossed eyes), amblyopia (lazy eye), and glaucoma. Often, these additional problems can be treated.

Because babies with ROP are born prematurely, they often suffer from other problems of prematurity including:

  • Respiratory distress syndrome (extreme difficulty breathing)
  • Bronchopulmonary dysplasia (chronic lung disease)
  • Anemia
  • Infection
  • Congenital heart disease
  • Low blood sugar
  • Hyperbilirubinemia (indicating liver problems)
  • Severe intestinal inflammation
  • Delayed growth and development

V. What Is the Cause of ROP?

Retinopathy of prematurity is the result of a number of complicated issues. The eye of the fetus begins to develop about the sixteenth week of pregnancy. At this time, blood vessels of the retina begin to grow, starting at the optic nerve and spreading gradually to the edges of the retina. These vessels deliver oxygen and nutrients to the developing tissue.

Then, during the last 12 weeks of pregnancy, the eye and blood vessels begin a period of rapid growth. This development and spread of blood vessels of the retina continues past the birth of the infant until about the time the baby is a month old. If the infant is born prematurely, however, this normal, rapid growth of the blood vessels toward the edge of the retina stops. This deprives these peripheral areas of the retina of oxygen and nutrients to keep the tissue living.

Researchers speculate that in an attempt to procure more oxygen and nutrients, the edges of the retina somehow sends signals to other parts of the retina inducing the growth of new blood vessels to carry the needed oxygen and nutrients. These new, extra blood vessels are the problem. They are very fragile and bleed. Scars are formed on the retina and when the scars shrink, as scars tend to do, they pull the retina off of the back of the eye. In effect, this detaches the retina.

VI. How Is ROP Treated?

The sooner the infant with ROP is treated, the better are the chances for curing the condition. According to PubMedHealth, a publication of the National Institutes of Health, doctors should begin to treat ROP within 72 hours of its diagnosis. Since ROP occurs in premature babies, checking for ROP is one of the doctor’s first tasks. Thus, treatment should begin about three days after the infant is born.

The most important factor in avoiding permanent damage is to diagnose and treat the baby early. Treatments include cryosurgery, or freezing the tissue to stop more abnormal blood vessels from growing. Another treatment, laser therapy or photocoagulation, is used to stop blood vessels from growing and stem the complications of advanced retinopathy of prematurity. If laser therapy is to cure the disease, it has to be started before retinal scarring and detachment occur.

Both laser therapy and cryotherapy destroy the edges or periphery of the retina, preventing further growth of abnormal blood vessels. These treatments are used only for babies with advanced ROP, especially infants having Stage III with "plus disease." However, this type of treatment, which is invasive surgery, also damages peripheral vision.

Other surgery to reattach a detached retina also may be tried.

VII. What Can I Do if ROP Surgery Doesn’t Work?

Clinical trials are ongoing to test new improved methods for treating ROP. The best answer to curing ROP is still early detection and treatment.

VIII. How Can an ROP Lawyer Help Me?

Hospital nurseries in the 1940s and 1950s used to give infants in incubators excessively high levels of oxygen as a routine part of their treatment. The number of babies born with retinopathy of prematurity shot up. Studies supported by the National Institutes of Health looked into this epidemic of new ROP cases and found too much oxygen was the culprit. Nurseries cut back on the amount of oxygen being given to the infants, and the cases of ROP declined.

Improper medical care of the baby with ROP may be a reason to file a lawsuit against healthcare personnel or an institution. If the condition was diagnosed too late or proper treatment was not provided, you can contact an ROP lawyer to find out if you have a legitimate case. To reach a retinopathy of prematurity attorney, contact us today.

IX. How to Initiate an ROP Lawsuit

Perhaps you suspect medical mistakes had something to do with your infant’s ROP. Late diagnosis, failure to diagnose the condition, or inappropriate medical care may be legitimate reasons for bringing a lawsuit against healthcare workers or a hospital.

If your baby has ROP and you have questions about whether the condition is due to human error, call our ROP lawyers today. A qualified ROP attorney will review the details of your case to determine if you have a legitimate claim. To find out what it will take to pursue an ROP lawsuit, please contact us today.