Retinopathy of Prematurity Prognosis

It is estimated that over 80 percent of premature infants who weigh less than 1,000 grams or 2.2 pounds will develop a condition called retinopathy of prematurity (ROP). The eyes of most of these babies will become normal without being treated.

The prognosis for retinopathy of prematurity depends on the stage of the disease when it is detected and the skill of the doctor treating the eyes. The sooner the condition is detected and appropriate treatment is administered, the better the prognosis.

As its name implies, the disease occurs in babies whose eyes have not finished developing when they are born prematurely. The eyes of babies born at term (40 weeks) have had a chance to fully develop. The blood vessels of the normal eye have had time to grow and extend from the back of the eye where they originate at the optic nerve to the front of the eye.

In premature infants, this process is interrupted when they are born before they reach 40 weeks’ gestation. The eye’s blood vessels begin to grow from the retina toward the center of the eye.

Stages of ROP

The severity of ROP is classified according to five stages. The definitions and prognoses of the eyes at different stages are:

  • Stage I: This is the mildest form of ROP. It occurs in babies born closer to term. Blood vessel growth in their eyes is mildly abnormal and they usually get better without treatment. The ophthalmologist sees a line between the area of the eye that has blood vessels (vascularized) and the area of the eye without blood vessels (avascular).
  • Stage II: The eyes of babies at this stage of retinopathy also tend to get better on their own. The line between the vascularized and avascular regions of the eye has become a raised ridge.
  • Stage III: This is moderate to severe ROP and usually requires treatment. At this stage, the baby’s eye can be seen to have undesirable blood vessels proliferating from the retina to the center of the eye. Abnormalities can lead to retinal detachment.
  • Stage IV: This is moderate to severe ROP and usually requires treatment. At this stage, the baby’s eye can be seen to have undesirable blood vessels proliferating from the retina to the center of the eye. Abnormalities can lead to retinal detachment.
  • Stage V: The retina at this stage is fully detached.

Treatments and Prognosis of ROP

Some babies with Stage III disease in which blood vessel growth is severe enough may be treated with laser surgery at the level of the peripheral retina. While this treatment can reduce the chance that ROP will progress to the potentially blinding stages IV and V, it does not completely eliminate it.

At Stages IV and V, when the retina is partially or fully detached, another ROP treatment called scleral buckling may be used. This involves putting a silicone band around the eyeball to attempt to decrease the tugging on the retina. When this therapy is used, retinal reattachment is successful in 70 percent of the infants.

Other surgery, called vitreous surgery may be used for some Stage IV eyes when the retina that produces central vision is detached or for Stage V when the whole retina is detached. This surgery, called vitrectomy, is the removal of the vitreous, a gel-like material that fills the back of the eye. The success rate for this procedure is 76 percent.

Sadly, 28 percent of children who have vitreous surgery and are managed properly end up with no light perception.

More recently, doctors are operating on Stage IV eyes earlier. This is done when the retina, which relays central vision, is still attached. Vitreous surgery in these children has been successful 90 percent of the time.

Help for Parents

If your baby is diagnosed with ROP, you may be eligible for compensation to help pay for expensive medical treatments and care. To learn more, contact our ROP lawyers today.