Understanding Retinopathy of Prematurity (ROP) in the NICU
When a baby is born prematurely, their organs—including their eyes—may not be fully developed. One of the conditions that can affect premature infants in the NICU is Retinopathy of Prematurity (ROP), a potentially serious eye disorder that requires early monitoring and, in some cases, treatment to preserve vision.
If your baby is in the NICU, you may hear medical teams mention ROP during routine screenings. Here’s what you need to know about what it is, why it happens, and how NICUs work to detect and manage it early.
What Is Retinopathy of Prematurity?
Retinopathy of Prematurity is a disease that affects the retina, the layer of tissue at the back of the eye that senses light and sends visual signals to the brain. In babies born too early—typically before 31 weeks gestation or with a birth weight under 1500 grams—the blood vessels in the retina may not have had enough time to develop properly.
In ROP, abnormal blood vessels can grow in the retina. These vessels are fragile and can leak, leading to scarring, detachment of the retina, and—in severe cases—permanent vision loss or blindness.
Why Does ROP Happen?
During the third trimester of pregnancy, blood vessels grow steadily across the retina. When a baby is born early, this development is interrupted. Exposure to oxygen outside the womb and other factors in the NICU environment can affect how the blood vessels grow, sometimes leading to the abnormal growth seen in ROP.
Several factors increase the risk of ROP, including:
Very low birth weight
Extreme prematurity
Fluctuating oxygen levels
Respiratory distress or other serious medical conditions
How Is ROP Diagnosed in the NICU?
ROP doesn’t cause obvious symptoms in the early stages, which is why routine eye screenings are crucial for premature infants. NICUs follow strict screening guidelines based on gestational age and birth weight. An ophthalmologist will perform an eye exam using a special instrument called an indirect ophthalmoscope, often beginning several weeks after birth.
ROP is classified by stages (1 through 5) based on severity:
Stage 1–2: Mild to moderate changes, often resolve without treatment
Stage 3: More significant changes that may require close monitoring
Stage 4–5: Severe cases with partial or complete retinal detachment
The earlier ROP is identified, the better the outcome—especially if treatment is needed.
What Are the Treatment Options?
Most mild cases of ROP resolve on their own without intervention. However, if the condition progresses or reaches a threshold where vision is at risk, treatment is necessary. Options include:
Laser therapy to stop abnormal blood vessel growth
Anti-VEGF injections, which block signals that trigger abnormal vessel development
Surgery in rare cases involving retinal detachment
Timely treatment can prevent vision loss and, in many cases, preserve normal or near-normal vision.
What Can Parents Expect?
Hearing that your baby is being screened for an eye condition can be scary—but ROP is a well-understood part of NICU care. Your baby’s care team will monitor their eyes closely and involve a pediatric ophthalmologist as needed. If treatment is recommended, it will be explained thoroughly, and you’ll have the opportunity to ask questions and be part of the decision-making process.
Looking Ahead
Most babies who experience ROP, especially those who receive early treatment, go on to have good visual outcomes. However, they may need long-term follow-up with a pediatric eye specialist to monitor for vision problems such as nearsightedness, strabismus (eye misalignment), or amblyopia (lazy eye).
At NEOwell, we know that NICU life brings many unknowns—and sometimes overwhelming terms like ROP. Our goal is to help you feel informed, empowered, and supported every step of the way. Reach out if you have questions or need support.