What is ROP ?

Retinopathy of Prematurity, often referred to as ROP, is a significant eye condition that primarily impacts the retina, which is the nerve tissue located at the back of the eye, in premature infants who are born with low birth weight.

In India, the national guidelines established 2018 regarding ROP stress the importance of timely screening. They recommend that all infants born weighing less than 2000 grams and/or those born prematurely at less than weeks of gestation should undergo their initial ROP screening before they reach 30 days of age. Alternatively, this screening should take place before the infant is discharged from the hospital, depending on which event occurs first.

Following the first screening, the necessity for follow screenings will be determined based on the findings observed. On average, a baby may require between three to five screening sessions to be officially declared 'free from ROP,' provided that no signs of the disease develop during any of the screening appointments. It is important to note that these screening sessions are typically scheduled to occur every one to three weeks, that each infant receives the appropriate monitoring and care as needed.

Braving the Light:

A Child’s Journey Through ROP Surgery
Watch as this little fighter undergoes a crucial procedure to save their vision from Retinopathy of Prematurity (ROP). A testament to resilience, hope, and the power of medical care.

Causes for ROP

ROP, or Retinopathy of Prematurity, occurs due to the incomplete development of the blood vessels that supply the retina when a premature baby is born. After birth, these blood vessels are supposed to grow and mature; however, this process does not always happen, affecting approximately 30-40% of premature infants. In some instances, a thick ‘barrier’ forms instead, which can lead to further complications. If this barrier grows excessively, it can reach a stage of ROP that varies based on its size and can cause permanent damage to the retina if appropriate treatment is not administered promptly.

Effect of ROP on the Eyes

About one in every 18 babies who are born prematurely is at risk of developing retinopathy of prematurity (ROP), a condition that necessitates medical intervention to prevent further complications. While many of these infants will ultimately develop their retinal blood vessels without any treatment, it is to conduct follow-up examinations to ensure that their development is on track. If timely treatment is not provided, there is a significant risk that the entire retina could suffer damage, potentially resulting in retinal det. This scenario can lead to permanent blindness or severe visual impairment for the child. It is profoundly distressing to see such vulnerable, tiny infants facing the prospect of irreversible blindness, especially when these outcomes are largely preventable with appropriate care and timely intervention.

Stages of ROP

ROP has five stages.

To stage these eyes, the barrier is assessed. A thin barrier is Stage 1 . Stage 2 is diagnosed when the barrier thickens in height and width. Stage 3 is a critical stage, when there are abnormal blood vessels and tissue growing on the barrier and out of it causing bleeding and leakage. Stage 4 is when the barrier increases and lifts the retina from its normal position (detachment) first in the edge (retinal periphery) and then in the visual centre.

Stage 5 occurs when the retina is totally detached. Another form of severe ROP is the ‘Aggressive ROP’ (called AROP) where stages 1 to 3 are skipped and it goes directly to stage 4 and 5. This form of ROP has very less window period or duration for treatment which is typically less than 48 hours & success rate varies from the classical ROP which follows stages. However, babies which have Aggressive ROP may be approached with a different treatment criteria involving requirement of injection and followed by laser, which may again vary from case to case. Unfortunately, it is estimated that up to 30% of ROP that requires treatment could be aggressive ROP in India at this time.

ROP intervention:

Have A Heart Foundation has provided the required camera for the screening and laser equipment along with two trained Technicians for outreach screening activities to Sewa Sadan Eye Hospital, Bhopal. Till August 2022, 520 babies were screened and 29 babies were treated with laser procedure to save them from going permanently blind. (The numbers are approximately equal to the world wide average of one in 18)
In Jaipur, we have provided two screening cameras – one to cover all the Government hospitals and one for the Private and peripheral hospitals. A dedicated Technician has joined the team and from June we plan to start the outreach activities. From January 2022, till September, we have supported treatment of 30 babies and prevented them from going blind.
GB Pant Government Hospital in Srinagar has an Opthalmologist who screens babies in the NICU and also does laser for babies found with ROP. Since the work was done manually, the Opthalmologist had the challenge of maintaining the record of the babies who require follow up. A portable camera from Forus is provided to ease the process and is being efficiently used at the hospitals after the Opthalmologist was trained for one week by Dr. Anand in Bengaluru. Till September 2022, a total of 239 babies were screened at the hospital.