This document provides an overview of Retinopathy of Prematurity (ROP), which is a vascular disorder of the retina that occurs primarily in preterm infants. ROP can potentially lead to permanent blindness if not treated properly. The document discusses who is at risk for ROP, including preterm infants born before 34 weeks gestation or weighing less than 2kg. It outlines recommended screening guidelines to detect ROP, including screening all high-risk infants by one month of age. Timely screening and treatment can prevent blindness in most cases of ROP.

1. Retinopathy of Prematurity (ROP)

2. PBMA’S H. V. DESAI EYE HOSPITAL
Learning Objectives:
At the end of this lecture you should be able to know
- What is ROP?
- Why is ROP relevant for India?
- Who are at risk of ROP?
- When to screen for ROP and screening methods.

3. PBMA’S H. V. DESAI EYE HOSPITAL
Let’s start with a quiz…
• ROP is a disease of…
-cornea
- retina
- lens
• ROP occurs in…
- school children
- infants
- old persons

4. PBMA’S H. V. DESAI EYE HOSPITAL
• Potential impact of ROP on vision…
- no impact
- blindness
- mild blurring of vision

5. PBMA’S H. V. DESAI EYE HOSPITAL
• Definition - Vascular disorder of the retina
which occurs principally in the preterm infants.
• Specifically, occurs in the incompletely
vascularized retina.
• May lead to permanent blindness in a child.
Introduction

6. PBMA’S H. V. DESAI EYE HOSPITAL
Likely distribution of blindness in children due to retinopathy of prematurity using infant
mortality rates as an indicator. [Eye 2007 21: 1338−43].
Why do you think IMR can be a proxy indicator for estimating distribution of ROP blindness??

7. PBMA’S H. V. DESAI EYE HOSPITAL
Courtesy: Prof. Clare Gilbert, LSHTM, London

8. PBMA’S H. V. DESAI EYE HOSPITAL
Why should we care?
Poverty
relationship
s
Development
Isolation
Impact of Blindness*-
1. Kulkarni, S; Gilbert, C; Zuurmond, M ; Agashe S; Deshpande M. Blinding Retinopathy of Prematurity in Western India: Characteristics of Children, Reasons for Late Presentation and Impact on Families. 2018;55:665–70.

9. PBMA’S H. V. DESAI EYE HOSPITAL
Can you differentiate between ‘normal’ and ‘abnormal’?

10. PBMA’S H. V. DESAI EYE HOSPITAL
ROP : Who is at risk?
-Preterm (born < 34 weeks of pregnancy)
- low birth weight (< 2Kg ) infants
OR
- Bigger Infants (> 2kg) with critical illness during first
month after birth
Biggest baby treated by us- 2.4 kg BW

11. PBMA’S H. V. DESAI EYE HOSPITAL
Risk Factors:
• Prematurity - <34 weeks/ < 2kg
• ‘Unmonitored’ oxygen supply
• Infection (sepsis)
• Anemia requiring Blood transfusion
• Multiple births and many more…..

12. PBMA’S H. V. DESAI EYE HOSPITAL
ROP screening : Why?
• Premature babies are not born with the
disease
• ROP starts developing after 2-3 weeks of
birth.
• Blindness preventable with timely treatment
in most cases.

13. PBMA’S H. V. DESAI EYE HOSPITAL
ROP Screening - When
Govt of India guidelines 2017
• First screening: at or before Day 30 of life
• For extremely premature baby(<1200 gm/ <30 weeks): Day 20

14. PBMA’S H. V. DESAI EYE HOSPITAL
Screening: How?
Indirect Ophthalmoscopy

15. PBMA’S H. V. DESAI EYE HOSPITAL
Screening: How?
Imaging with a Digital Camera

16. PBMA’S H. V. DESAI EYE HOSPITAL
Do all preterm babies develop ROP?
• Less than half 20-44% (Indian reports)
• Sight threatening ROP: 3-10%
• Only sight threatening ROP requires laser treatment/
injections.
• Complications of ROP (retinal detachment) require surgery.
Good news: 90/100 preterm babies DO NOT develop blinding
ROP.

17. Stage 1 Stage 2 Stage 3
Stage 4 APROP
Post Laser stage 5
How does ROP look like?

18. PBMA’S H. V. DESAI EYE HOSPITAL
Is a preterm child free of risk once ROP is taken care of?
• No
• Other ocular diseases not uncommon in preterm*:
- High myopia
- Amblyopia, squint
- Cataract, glaucoma
- Delayed visual maturation
- Retinal detachment
1. Kulkarni Sucheta; Shah Mukti, Dole Kuldeep et al. Ocular Outcomes and Co-morbidities in preterm infants enrolled for Retinopathy of Prematurity screening: a Cohort study
from Western India. Oman J Ophthalmol. 2018;

19. PBMA’S H. V. DESAI EYE HOSPITAL
Need of follow up
• Every 3 months till 1 yr of age.
• Every 6 months thereafter till 3 yrs.
• Annual check up after 3 yrs.
Laser treated babies need lifelong follow up.

20. PBMA’S H. V. DESAI EYE HOSPITAL
What can we do to prevent ROP?
• Not possible in ALL cases but…
• Tight monitoring of oxygen supply
• Hand hygiene (prevent infection)
• Mother’s milk- weight gain, reduced infection

21. PBMA’S H. V. DESAI EYE HOSPITAL
KBC Time again……..
• Write your ‘code number’ on the top of a sheet of paper.
• Write your answers in front of question number.
(Example- Q 1- b, Q 3- a and so on)
• Exchange your answer sheet with your neighbor after
completion.
• Check your neighbor’s answers- One mark for each correct
answer.

22. PBMA’S H. V. DESAI EYE HOSPITAL
1. Blindness from ROP is preventable.
a. True
b. False
2. Birth weight cut off for ROP screening.
a. 1 kg
b. 2 kg
c. 2.5 kg

23. PBMA’S H. V. DESAI EYE HOSPITAL
3. What can a mother do to reduce risk of ROP in her child?
a. Oxygen monitoring
b. Observe eyes
c. breastfeeding

24. PBMA’S H. V. DESAI EYE HOSPITAL
4. What will you advise to a family of newborn preterm baby?
a. Ask your pediatrician about ROP screening.
b. Go to any ophthalmologist for ROP check up.
c. Go to a nearby PHC for screening.

25. PBMA’S H. V. DESAI EYE HOSPITAL
5. Your neighbor’s preterm child (BW 1.5 kg) is now 2 weeks old
and discharged from NICU. Parents were told about eye check up
but not told when? When would you advise them to get their
child’s ROP screening done?
At or before-
a. 3 months
b. 6 months
c. 1 month
Exchange your answer sheet with your neighbor and give 1 mark for each correct answer.

26. PBMA’S H. V. DESAI EYE HOSPITAL
Thank you!!!