Key points about treatment for retinopathy of prematurity
- if your baby is diagnosed with retinopathy of prematurity (ROP), they can have treatment
- the healthcare team will consider 3 things when deciding if pēpi need ROP treatment, including the stage and location of ROP
Please talk with hospital staff when you have questions about ROP treatment or need support.
Find out more about retinopathy of prematurity and the eye exam to diagnose the condition.
Retinopathy Of Prematurity Eye Exam
Retinopathy of prematurity - stages and zones
There are 3 important things the healthcare team will consider when deciding if pēpi need retinopathy of prematurity (ROP) treatment to prevent vision impairment or permanent blindness.
Stages
There are 5 stages of ROP. The stages describe the progression of the condition.
Zones
There are 3 zones of ROP. They describe the location of ROP in the retina.
The presence of 'plus disease'
'Plus disease' in ROP means the blood vessels are twisted and enlarged.
Stages of ROP
Stage 1
Stage 1 ROP: There is a line that separates the normal and peripheral retina (no blood vessels).
Source: KidsHealth
transcribeTranscript
The illustration shows a close-up cross-section of an eyeball, labelled Retinopathy of prematurity – Stage 1.
- Red blood vessels are visible spreading from the optic nerve at the back of the eye but stop halfway across the retina.
- A thin line forms at the edge of the developed area.
At the top right is the KidsHealth logo with the website address: kidshealth.org.nz.
Stage 2
Stage 2 ROP: The line develops into a visible elevated ridge of tissue.
Source: KidsHealth
transcribeTranscript
The illustration shows a close-up cross-section of an eyeball, labelled Retinopathy of prematurity – Stage 2.
- Red blood vessels are visible spreading from the optic nerve at the back of the eye but stop halfway across the retina.
- At the edge of the developed area, a raised ridge of tissue has formed.
At the top right is the KidsHealth logo with the website address: kidshealth.org.nz.
Stage 3
Stage 3 ROP: Fragile new abnormal blood vessels grow and multiply towards the centre of the eye. Pēpi need treatment within 48 hours.
Source: KidsHealth
transcribeTranscript
The illustration shows a close-up cross-section of an eyeball, labelled Retinopathy of prematurity – Stage 3.
- Fragile new abnormal red blood vessels are growing and multiplying towards the centre of the eye. They are spreading from the optic nerve at the back of the eye.
At the top right is the KidsHealth logo with the website address: kidshealth.org.nz.
Stage 4
Stage 4 ROP: The retina has slightly detached, and pēpi need urgent treatment.
Source: KidsHealth
transcribeTranscript
The illustration shows a close-up cross-section of an eyeball, labelled Retinopathy of prematurity – Stage 4.
- There are fragile abnormal red blood vessels.
- The retina has slightly detached.
At the top right is the KidsHealth logo with the website address: kidshealth.org.nz.
Stage 5
Stage 5 ROP: The retina has completely detached, and urgent treatment may still result in vision loss or blindness.
Source: KidsHealth
transcribeTranscript
The illustration shows a close-up cross-section of an eyeball, labelled Retinopathy of prematurity – Stage 5.
- There are fragile abnormal red blood vessels.
- The retina has completely detached.
At the top right is the KidsHealth logo with the website address: kidshealth.org.nz.
Zones
- Zone I: A small area in the centre of the retina which covers the central visual area, including the macula and optic nerve.
- Zone II: The ring-shaped section of the retina surrounding Zone I.
- Zone III: The crescent-shaped outer edge of the retina.
ROP in Zone I is more likely to progress into a more serious condition than Zones II and III.
Retinopathy of prematurity zones I, II and III.
Source: KidsHealth
transcribeTranscript
The illustration shows a view of the back of the eye, as if looking into the eye from the front. It is labelled Zones.
Three circular zones are shown around the optic nerve:
- Zone I is the small central circle closest to the optic nerve and macula.
- Zone II is the larger ring around Zone I.
- Zone III is the outer crescent-shaped area near the edge of the retina.
Red and blue blood vessels spread outward from the optic nerve through the zones. The optic nerve and macula are labelled on the right side of the image.
At the top right is the KidsHealth logo with the website address: kidshealth.org.nz.
When treatment is needed
Treatment is recommended if any of the following features of the retina are found:
- if ROP is in Zone I, any ROP with plus disease
- if ROP is in Zone I, stage 3 without plus disease
- if ROP is in Zone II, stage 2 or 3 with plus disease
- ROP stages 4 and 5, with or without plus disease
Treatments for ROP
There 2 different treatments available in Aotearoa New Zealand:
- anti-VEGF eye injection
- laser surgery
Anti-VEGF (avastin) eye injection
VEGF (vascular endothelial growth factor) is a naturally occurring protein. It helps blood vessels develop. But VEGF can also sometimes cause the development of abnormal blood vessels in the retina, resulting in ROP. The anti-VEGF treatment stops this growth of abnormal blood vessels. This reduces the risk of stage 4 or 5 ROP, vision loss and permanent blindness.
Eye injection procedure
An ophthalmologist will inject the anti-VEGF medicine directly into the eye. This is a very fast procedure that usually takes just a few minutes. Your baby will usually have the eye injection in the neonatal intensive care unit (NICU). For this procedure, your baby's healthcare team will ask you to wait in another room.
Like the eye exam procedure, pēpi will have eye drops to dilate their pupils. To help ease pain and distress, pepī will:
- have numbing eye drops
- be swaddled
They can also have:
- expressed breastmilk
- a pacifier
- oral sucrose (sugar)
After the eye injection
Your baby will have dilated pupils for the rest of the day. This will return to normal by the next day.
Your baby may have slight redness in the white of their eyes. This can take 1 to 2 weeks to return to normal.
There is a small risk of infection following the eye injection. Your baby will have antibiotic eye drops for 5 days to prevent an infection.
Give your baby lots of cuddles and love after they have had the eye injection to help them feel comfortable.
After the eye injection, your baby will need eye exams:
- every week for 1 month
- then every 2 weeks for about 4 months
Laser eye surgery
Laser eye surgery uses fine and intense beams of light. The ophthalmologist will direct these beams to the area of the retina with abnormal blood vessels. The laser creates scar tissue. This helps stop the growth of abnormal blood vessels and allows normal retinal vessels to extend and fill in the empty area.
Before laser eye surgery, your baby will have a general anaesthetic. The ophthalmologist usually does laser eye surgery in an operating theatre. It takes about 1 to 2 hours.
After laser eye surgery
Give your baby lots of cuddles and love after they have had laser eye surgery to help them feel comfortable.
Your baby will need to wear an eye shade for 12 hours to protect the eye area. This is because their eyes will be a bit red and swollen. The skin area should return to normal within 24 to 48 hours. The eyes are often inflamed. Your baby will have steroid eye drops for a few days to help bring down the inflammation.
Most pēpi will only need one treatment but some pēpi need a second treatment 2 to 3 weeks later.
Support
For advice and support, call the Parent Helpline on 0800 568 856.
Call the Depression Helpline on 0800 111 757 or free text 4202.
