DR. MD Maksude Mowla › Services › Retinopathy of Prematurity (ROP) Screening
We provide specialized ROP screening and management for premature and low-birth-weight infants. Early diagnosis and prompt treatment help prevent childhood blindness and ensure the best possible visual outcome.
Our specialists are available 6 days a week for in-person and virtual consultations.
Retinopathy of Prematurity (ROP) is a potentially sight-threatening eye condition that develops in some premature babies. In a full-term pregnancy, the blood vessels that supply the retina complete their development just before birth. In premature babies, this process is interrupted — and after birth, exposure to the relatively higher-oxygen environment outside the womb can trigger abnormal blood vessel growth in the retina.
ROP ranges from mild changes that resolve on their own, to severe disease that can lead to retinal detachment and permanent vision loss if not treated promptly. The critical factor is early, systematic screening — because there are no visible signs or symptoms that parents or general nurses can reliably detect.
Our ROP Screening Programme provides timely, expert examination of all at-risk premature infants using internationally recommended protocols. With appropriate screening and treatment, the vast majority of babies with ROP will go on to have good vision.
ROP is classified into five stages based on the severity of abnormal vessel growth:
Stage 1 — Mildly Abnormal
A thin, flat demarcation line separates the vascularised retina from the peripheral avascular zone. Many cases at this stage resolve without treatment as normal vessel growth resumes.
Stage 2 — Moderately Abnormal
The demarcation line becomes an elevated ridge. Spontaneous resolution is still possible but the baby requires close monitoring.
Stage 3 — Severely Abnormal
Abnormal new blood vessels grow from the ridge into the vitreous cavity. Treatment is typically required at or beyond this stage.
Stage 4 — Partial Retinal Detachment
Scar tissue pulls part of the retina away from its underlying support layer. Surgical intervention is needed — outcomes are better when only part of the retina is detached (4A vs 4B depending on macula involvement).
Stage 5 — Total Retinal Detachment
The entire retina is detached. Even with surgery, the visual prognosis is very poor — highlighting why early screening and intervention at an earlier stage is so vital.
Plus Disease
A modifier indicating more severe disease at any stage. Characterised by dilation and twisting (tortuosity) of retinal blood vessels near the optic disc — signals aggressive disease requiring urgent treatment.
ROP is diagnosed through specialist eye examination — babies cannot describe visual symptoms. However, the following factors determine which babies require screening:
Who needs ROP screening?
• All babies born before 32 weeks gestational age
• All babies with birth weight below 1500 grams
• Selected babies born 32–36 weeks with additional risk factors
Risk factors that increase ROP severity:
• Earlier gestational age at birth (the more premature, the higher the risk)
• Lower birth weight
• Prolonged supplemental oxygen therapy
• Respiratory distress requiring mechanical ventilation
• Anaemia requiring blood transfusions
• Infection or sepsis in the newborn period
• Multiple births (twins, triplets)
Physical signs in advanced or missed cases:
• White or cat’s-eye reflex from the pupil (leukocoria)
• Inward or outward turning of an eye (strabismus)
• Poor visual interest or tracking
• Abnormal eye movements (nystagmus)
If you notice any of the above in your premature baby, please contact us immediately.
ROP screening is performed by a trained ophthalmologist using indirect ophthalmoscopy.
When is the first examination performed?
• Born before 27 weeks: First examination at 31 weeks post-menstrual age
• Born 27–32 weeks: First examination 4 weeks after birth
How is the examination performed?
• Dilating eye drops are instilled 30–60 minutes before the examination
• A small, sterile speculum gently holds the eyelids open
• The entire retina is examined systematically using indirect ophthalmoscopy and a scleral depressor
• RetCam digital retinal photography may be used to document findings and enable remote consultation
Follow-up examination schedule based on findings:
• No ROP, normal retinal vessels — 2-weekly review
• Immature vessels in zone I or II — Weekly or bi-weekly
• Pre-threshold or Type 1 ROP — Treatment within 48–72 hours
• Stage 4 or 5 — Immediate surgical referral
Our team explains all findings clearly to parents at every visit and is always available to answer questions.
When treatment is indicated, it must be delivered promptly — ideally within 48–72 hours of diagnosis of Type 1 ROP.
Laser Photocoagulation (Laser Ablation)
The most widely used treatment for ROP. Laser is applied to the avascular peripheral retina (the area without blood supply) to eliminate the stimulus for abnormal vessel growth. Performed under general anaesthesia or deep sedation. Highly effective for threshold ROP, with most treated eyes going on to develop good vision.
Intravitreal Anti-VEGF Injection
Anti-VEGF medication (bevacizumab or ranibizumab) is injected directly into the vitreous cavity of the baby’s eye. This rapidly halts abnormal vessel growth, even in aggressive posterior ROP (AP-ROP) where laser may not be technically possible. The drug effect is temporary, so longer follow-up is required to ensure normal vascularisation is completed.
Vitrectomy Surgery (Stage 4 and 5 ROP)
For babies with retinal detachment, surgery is required to remove scar tissue and reattach the retina. Outcomes depend significantly on whether the macula is involved and how early surgery is performed.
After treatment for ROP, long-term follow-up is essential — both in the immediate period and throughout childhood:
After laser treatment:
• Review at 1 week to confirm regression
• 2-weekly follow-up until full retinal vascularisation is confirmed
• Then annual review through childhood
After anti-VEGF injection:
• More frequent follow-up is required (weekly for several months) as vessel growth may resume after the drug effect wears off
• Continue until retinal vascularisation is fully complete
Long-term childhood eye care:
• Annual refraction — ROP is associated with myopia (short-sightedness) and astigmatism
• Amblyopia (lazy eye) monitoring and treatment if needed
• Strabismus (squint) assessment — more common in premature babies
• Visual acuity and visual field testing as the child develops
Guidance for parents:
• Attend all scheduled appointments — ROP can progress rapidly between visits
• Inform your paediatrician and school about the ROP history at every check-up
• Children with treated ROP may need spectacles from as early as 12–18 months
• Early spectacle correction gives the best chance of optimal visual development
Common questions about ROP screening and treatment in premature infants
ROP is a potentially blinding eye disorder that can develop in premature or low-birth-weight babies. It occurs when abnormal blood vessels grow and spread through the retina, which may lead to retinal detachment and permanent vision loss if not detected and treated promptly.
Screening is recommended for all infants born before 32 weeks of gestation, those weighing less than 1,500 grams at birth, and selected larger or older infants who had an unstable clinical course including supplemental oxygen therapy. Your neonatologist and ophthalmologist will determine eligibility.
The first screening is usually performed at 4–6 weeks of chronological age or 31–32 weeks post-menstrual age, whichever is later. The examination is carried out using an indirect ophthalmoscope after dilating the infant’s pupils, and findings are classified by stage and zone.
Treatment depends on severity. Laser photocoagulation is the most common approach, performed under sedation or general anaesthesia. In selected cases, intravitreal anti-VEGF injections may be used. Advanced stages with retinal detachment may require vitreoretinal surgery.
Treatment significantly reduces the risk of severe vision loss but does not guarantee perfectly normal vision. Children treated for ROP require long-term ophthalmological follow-up to monitor for refractive errors, amblyopia (lazy eye), strabismus, and other visual problems as they develop.
