Retinopathy of Prematurity (ROP): A Comprehensive Guide for Parents and Caregivers

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

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

1. Can ROP resolve on its own?

Yes – Stages 1 and 2 often regress spontaneously without any treatment. However, this must be confirmed through serial eye examinations by a qualified ophthalmologist. Never assume the condition has been resolved without professional verification.

2. Will my baby need glasses after ROP?

Premature infants are at significantly higher risk of myopia and other refractive errors, whether or not they develop ROP. Regular checks from infancy onwards are strongly recommended so that spectacles, patching, or other interventions can be started promptly if needed. 

3. How soon after treatment can we expect to know if it worked?

Your ophthalmologist will typically schedule a follow-up examination within one to two weeks of treatment to assess the response. Several follow-up visits are usually needed before the disease is considered stable. Open communication with your care team throughout this period is essential. 

4. Is ROP hereditary?

ROP itself is not a genetic or hereditary condition – it is caused by the circumstances of preterm birth. However, some underlying conditions that increase the risk of premature birth may have genetic components. If you have concerns about future pregnancies, a discussion with your obstetrician or a genetic counsellor may be helpful.

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.