Screening and Symptoms in ROP
Eyes of premature infants at risk for developing retinopathy of prematurity (ROP) should be initially examined in the neonatal intensive care unit (NICU) approximately 4 to 6 weeks after birth, followed by carefully timed interval examinations as determined by the examining ophthalmologist until retinal blood vessel growth is complete.1-3
For infants who have developed ROP, regular surveillance is essential to determine whether ROP changes have ceased or regressed, irrespective of treatment, as well as to determine whether treatment is necessary.1,2 Examination intervals are typically every 1 or 2 weeks, unless treatment is required; follow-up recommendations should be based on retinal findings and may require an altered interval frequency in order to optimize timely treatment.2-4
Ongoing acute screening examinations for ROP are required until the retina is vascularized into zone III without previous ROP in zones I or II, the infant is at least 45 weeks of postmenstrual age (PMA) without development of prethreshold ROP, or whose ROP has fully regressed.2,4 If ROP persists, assessments should continue until there are at least 2 consecutive exams without ROP and retinal vascularization is present in zone III.2 Treatment with intravitreal anti-vascular endothelial growth factor necessitates follow-up until at least 65 weeks PMA, with close follow-up during the highest risk for disease reactivation at 45-55 weeks PMA.4
Untreated, severe ROP has the following symptoms:5-7
- Leukocoria
- Myopia
- Nystagmus
- Strabismus
Even after acute screening is no longer required, long-term follow-up is critical due to higher risk for developing other eye problems, including amblyopia, cataract, glaucoma, strabismus, and high-refractive error.4 After NICU discharge, premature infants should be reexamined within 4 to 6 months.4
References
- National Organization for Rare Disorders (NORD) Rare Disease Database. Retinopathy of Prematurity. Last updated January 30, 2014. https://rarediseases.org/rare-diseases/retinopathy-of-prematurity/
- American Society of Retina Specialists (ASRS). RetinaAtlas. Retinopathy of prematurity (ROP). https://atlas.asrs.org/article/retinopathy-of-prematurity-rop-147
- Fierson WM, American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018;142(6):e20183061.
- Heidar K. Retinopathy of prematurity. EyeWiki®. Last reviewed Novemer 30, 2025. https://eyewiki.org/Retinopathy_of_Prematurity
- University of California San Francisco. Benioff Children’s Hospitals. Retinopathy of prematurity. https://www.ucsfbenioffchildrens.org/conditions/retinopathy-of-prematurity
- National Eye Institute. Retinopathy of Prematurity. Last updated August 6, 2025. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinopathy-prematurity
- ASRS. Retinopathy of Prematurity. https://www.asrs.org/patients/retinal-diseases/17/retinopathy-of-prematurity
- Tamura MYY, Teixeira LF. Leukocoria and the red reflex test. 2009. 7(3 Pt1):376-382. https://www.researchgate.net/publication/26851543_Leukocoria_and_the_red_reflex_test
- American Association for Pediatric Ophthalmology (AAPOS). Strabismus. Updated 10/7/2020. https://www.aapos.org/glossary/strabismus
All URLs accessed December 19, 2025.
