Retinopathy of Prematurity (ROP)

The blog post I didn't want to have to write; I was hoping Frankie would not get ROP (Retinopathy of Prematurity). I knew he was at risk because of his gestational age, low birth weight, use of oxygen, and anemia but I hoped we could skip it. Just like I am hoping he doesn't require a blood transfusion like many extreme preemies do.

His first eye exam at 31 weeks showed no signs. The paper the eye doctor left behind read "Your baby does not have ROP, but could develop problems later because the retinal blood vessels are still not fully mature. Your baby should have a ROP exam in 2 weeks." Alright, no big deal.

His second eye exam at 33 weeks showed stage 1 ROP (explanation of stages to follow), not requiring treatment, just follow-up in two weeks. This time I was here for the exam but they asked me to leave the unit. I went to fill up my water and it was done before I got back. The paper the eye doctor left behind read "Your baby has ROP. The ROP is not enough to require treatment. It is important to understand that ROP can change suddenly, placing your baby in danger. Your baby needs an ROP exam in 2 weeks." I could not believe that the eye doctor would not have stopped to talk to me. She just marked the box on the sheet. I asked for a second opinion and spoke to Frankie's neonatologists; as usual I did my research too.

Frankie just had another eye exam and the box was checked "Your infant's eyes have mature blood vessels and are at low risk for developing ROP. Other diseases, such as crossed eyes, lazy eye, and extreme nearsightedness, occur more frequently in premature infants and may only become apparent when the infants are older. Follow-up care for your infant will be on an as needed basis." And she wrote in "in six months."

While Frankie is in the clear now for ROP here is what I know about it:

• The blood vessels that supply the retina are one of the last parts of the eye to mature. Full term infants eyes are barely fully developed; so preterm infants still have some maturing to do in this area. Free radicals caused by excess oxygen(most preemies are on oxygen) can hinder this maturation process causing ROP.
  
• Added risk factors for ROP include premature birth (duh!), apnea, anemia, heart disease, infections, respiratory issues, bradycardia (slow heart rate), and blood transfusions... to name a few.
• ROP in infancy puts child at greater risk for retinal detachment, blindness or vision loss, nearsightedness, lazy eye, glaucoma, and crossed eyes.
  

Stages (how abnormal the blood vessels are) and whether or not treatment is required: 

1. Mild - no treatment require, often resolves on it's own.
2. Moderate - often no treatment required and also often resolves on it's own.
   
3. Severe - sometimes no treatment but sometimes treatment is required to prevent retinal detachment.
   
4. Severe plus partial retinal detachment - requires treatment.
   
5. Total retinal detachment - requires treatment, often surgery.
   

Great other resources to learn more:
​https://www.marchofdimes.org/baby/retinopathy-of-prematurity.aspx
​https://www.aao.org/eye-health/diseases/what-is-retinopathy-prematurity
​https://nei.nih.gov/health/rop/rop