ROPARD - The Association for Retinopathy of Prematurity and Related Diseases

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What is Retinopathy of Prematurity (ROP)
Stage 4 ROP
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Retinopathy of prematurity (ROP) has been divided into five stages.  Stages 1 and 2 customarily get better on their own.  Some eyes, however, go on to Stage 3 retinopathy of prematurity.

This happens when new blood vessels start to grow from the retina toward the center of the eye, forming a ridge between retina that has blood vessels in the back of the eye, and the retina that does not have blood vessels in the front of the eye.

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This difference in the blood vessels of the retina is because the premature baby has not had the time while in the womb to allow the blood vessels within the retina to grow all the way from the optic nerve in the back of the eye to the front of the eye. Stage 3 ROP exists when these disturbing new blood vessels grow out from the ridge in the retina toward the center of the eye.  If this blood vessel growth becomes severe and is accompanied by “plus” disease, the child may reach the point where treatment of the peripheral retina with laser (or rarely freezing) treatment is performed.  “Plus” disease is defined as enlarged and twisting blood vessels in the back part of the eye.

Peripheral retinal treatment can reduce, but not eliminate, the chance of the ROP progressing to the potentially blinding stages 4 and 5.  When stage 4 or 5 ROP is reached, the retina is detached and other therapies can be performed.One such therapy is scleral buckling, which involves encircling the eyeball with a silicone band to try and reduce the pulling on the retina.

Other therapies include vitrectomy (removal of the gel-like substance called the vitreous that fills the back of the eye).  Sometimes the removal of the lens as well is required during vitrectomy to try and eliminate as much pulling as possible from the retinal surface.  Removal of the lens is performed if the retina is touching the back surface of the lens,  which would make it impossible to enter the eye.  When scleral buckling is considered the appropriate procedure, the success rate is 70% retinal reattachment.

Vitreous surgery for stage 4B, where the retina responsible for central vision is detached, or stage 5, where all the retina is detached, had a success rate of 76% reattachment.

The child’s vision after these procedures were in the ranges of: 20/60 to 20/300 for 15% of eyes 20/60 to 20/800 for 30% of eyes 20/60 to 20/1900 for 48% of eyes (ambulatory vision) light perception for 72% of eyes

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Ambulatory vision is defined as being able to see objects and move around a room without stumbling or bumping into obstacles.  Unfortunately, 28% of children even with appropriate management and vitreous surgery end up with no light perception.