Medical Conditions

Retinopathy of Prematurity

Content reviewed against published AAP, AAPOS, NIH guidelines

Editorial policy

Last reviewed:

If your baby has been diagnosed with or you suspect retinopathy of prematurity, here is what the evidence says.

The short answer

Retinopathy of prematurity (ROP) is a condition affecting the developing blood vessels of the retina in premature infants. It is most common in babies born before 31 weeks of gestation or weighing less than 1,500 grams (3.3 pounds). In mild cases, the abnormal blood vessels regress on their own. In severe cases, the abnormal vessels can cause scarring, retinal detachment, and blindness. All at-risk premature infants receive screening eye exams in the NICU, and treatment (laser therapy or anti-VEGF injections) is highly effective when needed.

Key takeaways

  • Retinopathy of prematurity (ROP) is a condition affecting the developing blood vessels of the retina in premature infants. It is most common in babies born before 31 weeks of gestation or weighing less than 1,500 grams (3.3 pounds). In mild cases, the abnormal blood vessels regress on their own. In severe cases, the abnormal vessels can cause scarring, retinal detachment, and blindness. All at-risk premature infants receive screening eye exams in the NICU, and treatment (laser therapy or anti-VEGF injections) is highly effective when needed.
  • Usually normal when: Your premature baby had ROP screening exams that showed no ROP or only stage 1-2 ROP that resolved on its own
  • Call your doctor if: Your baby has been diagnosed with treatment-threshold ROP (stage 3 with plus disease), as treatment is needed within 72 hours to prevent retinal detachment and permanent vision loss
  • Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

Thousands of parents search for this exact thing. You are not alone.

By Age

What to expect by age

0-3 months

Screening for ROP typically begins at 4-6 weeks of age (or 31-33 weeks postmenstrual age, whichever is later). The eye exam is performed by an ophthalmologist using an indirect ophthalmoscope after dilating the baby's pupils. ROP is classified by stage (1-5), zone (location on the retina), and the presence of plus disease (dilated, tortuous blood vessels). Most mild ROP (stages 1-2) resolves without treatment.

3-6 months

Follow-up examinations continue until the retinal blood vessels have matured completely or until the ophthalmologist determines that the risk of ROP progression has passed. If ROP progresses to treatment-threshold disease (typically stage 3 with plus disease), treatment is performed urgently, usually within 72 hours. Treatment options include laser photocoagulation or intravitreal anti-VEGF injections.

6-12 months

By this age, ROP has typically resolved or been treated. However, children who had ROP (even if it resolved on its own) are at increased risk for other eye problems including myopia (nearsightedness), strabismus, amblyopia, and late retinal detachment. Regular ophthalmologic follow-up is recommended throughout childhood.

12 months+

Long-term follow-up is essential for all children who had ROP. Even mild ROP increases the risk of significant refractive errors, requiring glasses from an early age. Children who had severe ROP or required treatment need more frequent monitoring for late complications such as retinal detachment, glaucoma, or cataracts. Early intervention services should be utilized if vision impairment affects development.

What Should You Do?

When to take action

Probably normal when...
  • Your premature baby had ROP screening exams that showed no ROP or only stage 1-2 ROP that resolved on its own
  • The ophthalmologist has discharged your baby from ROP screening because the retinal vessels have matured normally
  • Your child who had mild ROP has normal vision development at follow-up exams
  • Your premature baby was screened appropriately and no treatment was needed
Mention at your next visit when...
  • Your premature baby has not been screened for ROP and you want to confirm it was done or arrange it
  • Your child had ROP and you notice them squinting, sitting close to the TV, or having difficulty seeing
  • You want to discuss the long-term eye care plan for your child who had ROP
Act now when...
  • Your baby has been diagnosed with treatment-threshold ROP (stage 3 with plus disease), as treatment is needed within 72 hours to prevent retinal detachment and permanent vision loss
  • A child with a history of severe ROP suddenly develops vision changes, a white pupil, or eye pain, which could indicate late retinal detachment or other serious complications requiring emergency ophthalmologic evaluation

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Retinopathy of Prematurity.

Things to mention

  • Your premature baby has not been screened for ROP and you want to confirm it was done or arrange it
  • Your child had ROP and you notice them squinting, sitting close to the TV, or having difficulty seeing
  • You want to discuss the long-term eye care plan for your child who had ROP

Observations to share

  • Your premature baby has not been screened for ROP and you want to confirm it was done or arrange it
  • Your child had ROP and you notice them squinting, sitting close to the TV, or having difficulty seeing
  • You want to discuss the long-term eye care plan for your child who had ROP

Urgent signs to report immediately

  • Your baby has been diagnosed with treatment-threshold ROP (stage 3 with plus disease), as treatment is needed within 72 hours to prevent retinal detachment and permanent vision loss
  • A child with a history of severe ROP suddenly develops vision changes, a white pupil, or eye pain, which could indicate late retinal detachment or other serious complications requiring emergency ophthalmologic evaluation

My notes

From ismybabyalright.com — free, evidence-based baby health guides

Milestone

Milestone Checklists by Age

Track your baby's developmental milestones from birth to 5 years with age-specific checklists.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is retinopathy of prematurity normal?
Retinopathy of prematurity (ROP) is a condition affecting the developing blood vessels of the retina in premature infants. It is most common in babies born before 31 weeks of gestation or weighing less than 1,500 grams (3.3 pounds). In mild cases, the abnormal blood vessels regress on their own. In severe cases, the abnormal vessels can cause scarring, retinal detachment, and blindness. All at-risk premature infants receive screening eye exams in the NICU, and treatment (laser therapy or anti-VEGF injections) is highly effective when needed.
When should I call the doctor about retinopathy of prematurity?
Your baby has been diagnosed with treatment-threshold ROP (stage 3 with plus disease), as treatment is needed within 72 hours to prevent retinal detachment and permanent vision loss A child with a history of severe ROP suddenly develops vision changes, a white pupil, or eye pain, which could indicate late retinal detachment or other serious complications requiring emergency ophthalmologic evaluation
When is retinopathy of prematurity normal?
Your premature baby had ROP screening exams that showed no ROP or only stage 1-2 ROP that resolved on its own The ophthalmologist has discharged your baby from ROP screening because the retinal vessels have matured normally Your child who had mild ROP has normal vision development at follow-up exams
What causes retinopathy of prematurity?
Retinopathy of prematurity (ROP) is a condition affecting the developing blood vessels of the retina in premature infants. It is most common in babies born before 31 weeks of gestation or weighing less than 1,500 grams (3.3 pounds). In mild cases, the abnormal blood vessels regress on their own. In severe cases, the abnormal vessels can cause scarring, retinal detachment, and blindness. All at-risk premature infants receive screening eye exams in the NICU, and treatment (laser therapy or anti-VEGF injections) is highly effective when needed. Common explanations include: Your premature baby had ROP screening exams that showed no ROP or only stage 1-2 ROP that resolved on its own. The ophthalmologist has discharged your baby from ROP screening because the retinal vessels have matured normally.
What should I mention to my pediatrician about retinopathy of prematurity?
You should mention retinopathy of prematurity at your next visit if: Your premature baby has not been screened for ROP and you want to confirm it was done or arrange it. Your child had ROP and you notice them squinting, sitting close to the TV, or having difficulty seeing. You want to discuss the long-term eye care plan for your child who had ROP.
Is retinopathy of prematurity normal at 0-3 months?
Screening for ROP typically begins at 4-6 weeks of age (or 31-33 weeks postmenstrual age, whichever is later). The eye exam is performed by an ophthalmologist using an indirect ophthalmoscope after dilating the baby's pupils. ROP is classified by stage (1-5), zone (location on the retina), and the presence of plus disease (dilated, tortuous blood vessels). Most mild ROP (stages 1-2) resolves without treatment.
Is retinopathy of prematurity normal at 3-6 months?
Follow-up examinations continue until the retinal blood vessels have matured completely or until the ophthalmologist determines that the risk of ROP progression has passed. If ROP progresses to treatment-threshold disease (typically stage 3 with plus disease), treatment is performed urgently, usually within 72 hours. Treatment options include laser photocoagulation or intravitreal anti-VEGF injections.
Should I go to the ER for retinopathy of prematurity?
Seek emergency care if your baby has been diagnosed with treatment-threshold ROP (stage 3 with plus disease), as treatment is needed within 72 hours to prevent retinal detachment and permanent vision loss, or if a child with a history of severe ROP suddenly develops vision changes, a white pupil, or eye pain, which could indicate late retinal detachment or other serious complications requiring emergency ophthalmologic evaluation. When in doubt, call your pediatrician's after-hours line for guidance.
Does retinopathy of prematurity go away on its own?
In many cases, retinopathy of prematurity resolves on its own, especially when your premature baby had ROP screening exams that showed no ROP or only stage 1-2 ROP that resolved on its own. By 12 months+, long-term follow-up is essential for all children who had ROP. Even mild ROP increases the risk of significant refractive errors, requiring glasses from an early age. Children who had severe ROP or required treatment need more frequent monitoring for late complications such as retinal detachment, glaucoma, or cataracts. Early intervention services should be utilized if vision impairment affects development.
AAPAAPOSNIH

References

  1. [1]American Academy of Pediatrics. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018;142(6):e20183061. AAP
  2. [2]American Association for Pediatric Ophthalmology and Strabismus. Retinopathy of Prematurity. AAPOS
  3. [3]National Eye Institute. Retinopathy of Prematurity. NIH

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources

Related Resources

Eye Discharge TriageMilestone ChecklistsWell-Baby Visit PrepBaby Tracker

Bottom line

Most cases of retinopathy of prematurity are normal. Talk to your pediatrician if your baby has been diagnosed with treatment-threshold rop (stage 3 with plus disease), as treatment is needed within 72 hours to prevent retinal detachment and permanent vision loss.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

Share:FacebookX

Was this page helpful?

Related Medical Concerns

My Baby's Head Shape Looks Abnormal

Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.

Achondroplasia (Dwarfism) in Babies

Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.

Adenoid Hypertrophy and Breathing

Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.

Adrenoleukodystrophy (ALD) in Babies

X-linked adrenoleukodystrophy (X-ALD) is a genetic disorder affecting about 1 in 17,000 newborns, caused by mutations in the ABCD1 gene on the X chromosome. It primarily affects boys and impairs the breakdown of very long-chain fatty acids (VLCFAs), which accumulate and damage the myelin sheath in the brain and the adrenal glands. The most severe form, cerebral ALD, typically affects boys between ages 4-10 with rapid neurological decline. Newborn screening now enables early detection, and hematopoietic stem cell transplant or gene therapy performed before significant brain involvement can be life-saving.

How to Advocate for Your Child's Needs

You know your child better than anyone, and your observations matter. If you feel something is not right with your child's development or health, you have every right to ask questions, request evaluations, and seek second opinions. Advocating for your child is not being difficult - it is being a good parent.

Agenesis of the Corpus Callosum (ACC)

Agenesis of the corpus callosum (ACC) is a condition in which the corpus callosum — the bundle of nerve fibers connecting the left and right hemispheres of the brain — fails to develop partially or completely. It occurs in approximately 1 in 4,000 births and is one of the most common brain malformations. ACC can be detected on prenatal ultrasound or postnatal MRI. Outcomes vary enormously: some individuals with isolated ACC have normal intelligence and minimal difficulties, while others (especially when ACC occurs alongside other brain abnormalities or genetic syndromes) may have significant developmental delays. The variability means that prenatal counseling and postnatal monitoring are both essential.