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 four to six 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 post-menstrual age (PMA) without development of prethreshold ROP, or 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 re-examined within 4 to 6 months.4


  1. NORD Rare Disease Database. Retinopathy of Prematurity.
  2. American Society of Retina Specialists (ASRS). RetinaAtlas. Retinopathy of prematurity (ROP).
  3. 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.
  4. Heidar K. Retinopathy of prematurity. EyeWiki®. Last reviewed May 30, 2022.
  5. University of California San Francisco. Benioff Children’s Hospitals. Retinopathy of prematurity.
  6. National Eye Institute. Retinopathy of Prematurity. Last updated June 24, 2022.
  7. ASRS. Retinopathy of Prematurity.
  8. Preemie Heroes. Retinopathy of Prematurity (ROP).
  9. Tamura MYY, Teixeira LF. Leukocoria and the red reflex test. 2009. 7(3 Pt1):376-382.

All URLs accessed 7/1/22.

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Scientific Council

Neil M. Bressler, MD

James P. Gills Professor of Ophthalmology
Professor of Ophthalmology, Johns Hopkins University School of Medicine
Wilmer Eye Institute, Johns Hopkins Medicine
Baltimore, MD

A. Paul Chous, MA, OD, FAAO

Specializing in Diabetes Eye Care & Education, Chous Eye Care Associates
Adjunct Professor of Optometry, Western University of Health Sciences
AOA Representative, National Diabetes Education Program
Tacoma, WA

Steven Ferrucci, OD, FAAO

Chief of Optometry, Sepulveda VA Medical Center
Professor, Southern California College of Optometry at Marshall B. Ketchum University
Sepulveda, CA

Julia A. Haller, MD

Wills Eye Hospital
Philadelphia, PA

Allen C. Ho, MD, FACS

Director, Retina Research
Wills Eye Hospital
Professor and Chair of the Department of Ophthalmology
Thomas Jefferson University Hospitals
Philadelphia, PA

Charles C. Wykoff, MD, PhD

Director of Research, Retina Consultants of Houston
Associate Professor of Clinical Ophthalmology
Blanton Eye Institute & Houston Methodist Hospital
Houston, TX



Clinician Scientific & Educational Resources

The RELIEF Clinical Toolkit is an online tool that aims to provide clinicians with up-to-date information on the presentation, prognosis, pathophysiology, and treatment strategies for retinopathy of prematurity (ROP). Click on one of the options below to learn more about ROP.

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/Complete Conference Management (CCM). This activity is supported by an independent medical education grant from Regeneron Pharmaceuticals, Inc.

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