Reviewed by Dr Manoharan Shunmugam, Vitreoretinal Surgeon of OasisEye Specialists | Last updated: July 2026
As a vitreoretinal specialist, few conditions demand earlier attention – or carry higher stakes – than Retinopathy of Prematurity (ROP). Every week in our clinics across Malaysia, we meet families who had never heard of ROP before their baby arrived early. This article explains everything you need to know: what ROP is, why it happens, how it is staged, what treatment can offer, and – most importantly, what you as a parent can do to protect your child’s vision.
What is Retinopathy of Prematurity?
Retinopathy of Prematurity (ROP) is a leading, yet preventable, cause of childhood blindness. When infants are born too early, incomplete blood vessel growth in the retina can trigger abnormal vessel development, potentially leading to scarring, retinal detachment, and permanent vision loss. Because early detection is critical to saving a child’s sight, our team is committed to rigorous screening protocols.
What Causes ROP?
The root cause is preterm birth itself, but several factors can compound:
- Oxygen levels: Your neonatologist will be able to advise you on the optimal oxygen level for your baby. Sometimes in spite of this, the normal signalling that guides blood vessel growth in the retina doesn’t occur and ROP develops.
- Systemic inflammation: Infection and inflammatory processes in a premature baby’s body can further damage fragile retinal vessels.
- Sepsis and intraventricular haemorrhage: These serious complications of prematurity are associated with an increased risk of developing ROP.
- Blood transfusions: Repeated blood transfusions may be required if haemoglobin levels are low, and as a result of this, altered oxygen-carrying capacity, blood vessel development is also affected.
- Poor postnatal weight gain: Growth velocity after birth is a recognised marker of ROP severity – infants who gain weight slowly may require more regular eye checks to monitor ROP status.
- Nutritional status and lung maturity: Both affect how effectively the body regulates the metabolic environment of the developing eye.
The 5 Stages of ROP: What Each One Means
Stage 1 – MildA faint demarcation line separated normal from abnormal retinal tissue. Most infants at this stage improve spontaneously without any treatment. Stage 2 – ModerateThe demarcation line develops into a raised ridge. Spontaneous regression is still common, but close monitoring is essential. Stage 3 – SevereAbnormal blood vessels grow from the ridge into the vitreous gel. This is the stage at which many infants require treatment. Stage 4 – Partial Retinal DetachmentScar tissue begins to pull the retina away from the back of the eye. Surgical intervention is necessary, though visual outcomes are more guarded. Stage 5 – Total Retinal DetachmentThe retina is completely detached. Even with surgery, some degree of permanent visual impairment is likely. This underscores why early detection is so critical – the vase majority of the Stage 5 cases are preventable through timely screening. |
Signs and Symptoms of ROP: What Parents Should Watch For
Early- stage ROP is invisible to the naked eye and can only be caught through dilated eye exams by an ophthalmologist. However, parents should watch for these signs of advanced disease:
- White pupil glow (leukocoria): A whitish reflection in photos or dim light. This is an urgent warning sign.
- Abnormal eye movements: Though this may be present in normally developing eyes within the first few weeks after birth, if your child’s eyes are turning in/out or shaking involuntarily and you are concerned, please get this checked by an Ophthalmologist.
- Lack of visual responsiveness: Failing to track objects, fixate on faces, or respond to light by a few months of corrected age.
If you notice any of these signs, contact a paediatric eye specialist immediately – do not wait for your next appointment.
Treatment Options for ROP
When ROP reaches a threshold requiring intervention, our team has several effective tools at our disposal. The choice of treatment depends on the stage of ROP, its severity and the individual clinical picture.
Laser Therapy (Laser Photocoagulation)
Laser photocoagulation is the long-standing and effective treatment for RIOP. Performed under local or general anaesthesia, it uses precise laser burns to ablate the unhealthy peripheral retina. This eliminates the tissue sending out abnormal growth signals, effectively stopping the disease.
Anti-VEGF Injections
A major recent advance in ROP management is anti-VEGF injections, which block the chemical signal driving abnormal vessel growth. They are especially valuable for aggressive or hard-to-reach cases and are often combined with laser therapy.
While an eye injection sounds daunting to parents, the procedure takes only seconds, uses local anaesthesia, and is well-tolerated. However, because ROP can sometimes recur, close and extended follow-up is essential following this treatment.
Vitreoretinal Surgery (Stages 4-5)
When a retinal detachment has occurred, surgical intervention by an experienced vitreoretinal surgeon offers the best chance of preserving some useful vision. Options include vitrectomy (removal of the vitreous gel and scar tissue) and scleral buckling (placing a silicone band around the eye to support the retina). Outcomes at Stages 4-5 are more variable, and some degree of permanent visual impairment may remain – reinforcing once again that prevention and early treatment are paramount.
Screening and Prevention: The Foundation of ROP Care
The most powerful tool we have against ROP is timely screening. According to the Ministry of Health Malaysia/s latest Clinical Practice Guidelines (2023), retinal examinations are recommended for infants who meet any of the following criteria:
- Gestational age less than 34 weeks
- Birth weight less than 1,750 g
- An unstable clinical course that puts them at high risk, as determined by the attending neonatologist or paediatrician (regardless of gestational age or birth weight)
Beyond the neonatal period, children who had significant ROP – even those treated successfully – require ongoing eye follow-up throughout childhood. Myopia (short-sightedness), amblyopia (lazy eye), strabismus, and glaucoma are all more common in this population, and early management of these conditions gives children the best possible visual outcomes as they grow.
Parents of premature infants should advocate for themselves: if your baby meets the screening criteria and has not yet been referred to an ophthalmologist, ask your neonatologist or paediatrician to arrange this as a matter of urgency.
Frequently Asked Questions About ROP
Infants born before 34 weeks gestation or with a birth weight below 1,750 grams carry the highest risk, as defined by the Ministry of Health Malaysia’s 2023 Clinical Practice Guidelines. Risk is further increased in babies who experience sepsis, intraventricular haemorrhage, repeated blood transfusions, prolonged supplemental oxygen, or slow postnatal weight gain. Your neonatologist will identify high-risk infants early and arrange the appropriate ophthalmology referral.
ROP is diagnosed through a dilated eye examination performed by an ophthalmologist using a specialised lens and indirect light source. Dilating drops are applied first to widen the pupil so the retina can be examined in full detail. Early-stage ROP produces no visible external signs and cannot be detected without this specialist examination. Serial examinations are required to monitor whether the disease progresses, stabilises, or regresses spontaneously.
Yes, untreated ROP can lead to permanent vision loss or blindness. However, the vast majority of cases are preventable when screening occurs at the right time and treatment is started promptly. Stages 1 and 2 often resolve without intervention; the risk of blindness becomes significant from Stage 4 onwards, particularly Stage 5, where total retinal detachment has occurred. Timely diagnosis remains the single most important protective factor.
ROP screening is available at major government hospitals and specialist eye centres across Malaysia. The Ministry of Health Malaysia’s 2023 Clinical Practice Guidelines define which infants qualify — gestational age below 34 weeks or birth weight below 1,750 grams. At OasisEye Specialists, ROP assessments are conducted by paediatric vitreoretinal specialist, Dr Manoharan Shunmugam at the Bangsar South, Kuala Lumpur clinic. Parents should request a referral from their neonatologist or paediatrician if one has not been arranged.
Without intervention, severe ROP can advance to retinal detachment. A Stage 4 or Stage 5 detachment requires complex vitreoretinal surgery — vitrectomy or scleral buckling — and even with successful surgery, some permanent visual impairment is likely. Stage 5, where the retina is completely detached, carries the most guarded visual prognosis. This is why prompt treatment at Stage 3, before detachment occurs, is critical to protecting a child’s long-term sight.
Many children treated successfully for ROP develop good functional vision and attend mainstream school without difficulty. However, children with significant residual vision impairment may benefit from low-vision support, adapted learning materials, or early childhood intervention programmes. Close collaboration between the ophthalmologist, paediatrician, and school is important to ensure any visual challenges are identified and supported early, particularly before formal literacy and numeracy skills are developed.
Medical Disclaimer
This article is written for general educational purposes and does not constitute medical advice. It is not a substitute for professional consultation with a qualified ophthalmologist. Individual clinical situations vary, and management decisions should always be made in partnership with your treating specialist.
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