Eye conditions in premature infants (e.g. ROP) — What parents should know

Premature infants face a range of medical challenges, and their eyes are no exception. Babies born early may have immature visual systems, making them more vulnerable to specific eye conditions such as retinopathy of prematurity (ROP), refractive errors, strabismus and long-term vision difficulties. 

Early detection and proper management can make a significant difference to a child’s lifelong visual development. For parents, understanding these conditions and the importance of timely eye assessments is crucial.

Understanding premature birth and why eye health is affected

A baby’s eyes continue to develop well into late pregnancy. When a baby is born before this process is complete, the structures responsible for clear vision — including the retina, optic nerve and blood vessels — may be underdeveloped.

One of the most important concerns is retinopathy of prematurity (ROP), a condition where abnormal blood vessel growth occurs in the retina. If untreated, severe ROP can cause scarring, retinal detachment and permanent vision loss.

Premature infants are also more likely to develop:

• Short-sightedness. (myopia)
  
  
• Long-sightedness. (hyperopia)
  
  
• Astigmatism
  
  
• Strabismus (eye misalignment)
  
  
• Delayed visual maturation.
  
  

Immature retinal blood vessels, low birth weight, oxygen fluctuations and overall health all influence eye development. This makes regular monitoring and specialist input essential.

What is retinopathy of prematurity (ROP)?

ROP occurs when the normal growth of retinal blood vessels is disrupted after premature birth. Instead of developing smoothly, blood vessels may grow abnormally or stop developing altogether. This can lead to bleeding, scar tissue and in severe cases retinal detachment.

Why are premature babies at risk?

• Babies born before 32 weeks or weighing less than 1,500 grams are at the highest risk.
  
  
• Fluctuations in oxygen levels after birth can influence vessel growth.
  
  
• Babies requiring intensive care or ventilation have increased susceptibility.
  
  

How is ROP detected?

ROP screening is a standard part of neonatal care. An ophthalmologist examines the baby’s eyes at specific intervals to track retinal development and identify any abnormal vessels early.

Regular screening ensures treatment is given at the right time — neither too early nor too late — for the best possible outcomes.

Levels of severity and what they mean

ROP is classified into stages based on severity, from mild to sight-threatening:

• Stage 1–2: Mild, usually resolves without treatment.
  
  
• Stage 3: Abnormal vessel growth increases and may require treatment.
  
  
• Stage 4–5: Retinal detachment, requiring urgent intervention to preserve vision.
  
  

Most babies fall into the milder categories, but close monitoring is essential because the disease can progress quickly.

Treatment options and how they help

If ROP progresses to a stage where treatment is required, acting at the right time is crucial. The main options include laser therapy, anti-VEGF injections and, in advanced cases, surgery. Each method aims to prevent further damage and give the retina the best chance to develop normally.

Laser treatment

Laser therapy gently treats the outer areas of the retina where abnormal blood vessels are forming. By reducing the retina’s oxygen demand, it helps stop the vessel growth that can lead to scarring or detachment.

It is the most common and proven treatment for ROP, usually completed in one session and highly effective in preventing disease progression.

Anti-VEGF injections

These injections deliver a medication that blocks signals causing abnormal blood vessel growth. They are especially helpful for more aggressive or central forms of ROP.

Anti-VEGF allows the retina to continue developing more naturally and often preserves a wider field of vision. Babies who receive this treatment need closer follow-up because the condition can return later.

Surgery

In severe cases where the retina begins to detach or scar tissue develops, surgery may be required. Procedures such as vitrectomy or scleral buckle aim to reattach the retina and stabilise the eye.

Although only needed in advanced ROP, timely surgery can significantly improve the chance of saving useful vision.

Other eye conditions linked with premature birth

Premature birth is associated with a number of visual challenges alongside ROP:

Refractive errors

Babies may develop myopia, hyperopia or astigmatism due to altered eye growth patterns. These often require glasses in early childhood.

Strabismus

Eye misalignment may occur due to immature eye muscles or poor visual development. Early intervention helps prevent amblyopia (“lazy eye”).

Amblyopia

Reduced vision in one eye may develop if the brain does not receive clear visual signals. This is treated with glasses, patching or vision therapy.

Long-term visual development issues

Even babies with mild or resolved ROP benefit from regular long-term follow-up, as visual processing and eye coordination may develop differently.

What parents can expect during screening and follow-up?

Eye examinations for premature infants are gentle but detailed. Parents can expect:

• Screening begins 4–6 weeks after birth, depending on gestational age.
  
  
• The ophthalmologist uses dilating drops and a special lens to view the retina.
  
  
• Follow-up intervals depend on the severity and progress of vessel development.
  
  
• Most babies continue to be monitored into infancy and early childhood.
  
  

Once the retina is fully developed and stable, screening frequency decreases, but ongoing paediatric eye reviews remain important.

Risks, long-term considerations and safety in premature eyes

Although most premature babies achieve good long-term visual outcomes, certain risks remain higher throughout childhood:

• Myopia and other refractive errors.
  
  
• Strabismus and amblyopia.
  
  
• Reduced depth perception.
  
  
• Higher lifetime risk of retinal problems in cases of severe ROP.
  
  
• Need for glasses earlier than full-term children.
  
  

Regular check-ups help detect these issues early, ensuring timely intervention and better visual development.

Why early intervention and specialist care matter?

Parents trust paediatric ophthalmologists for their ability to detect subtle changes, provide timely treatment and guide families through the follow-up process. Specialised neonatal screening programs and evidence-based treatment pathways ensure premature infants receive the safest, most accurate care.

Paediatric eye specialists provide:

• Expert screening using advanced diagnostic tools.
  
  
• Careful monitoring of retinal development.
  
  
• Clear communication with parents and neonatal teams.
  
  
• Early management of refractive or developmental issues.
  
  
• Long-term support for visual development and eye health.

This comprehensive, team-based approach offers the best chance for healthy vision throughout childhood.

Conclusion

Eye conditions such as ROP are an important part of caring for premature infants. With early screening, timely treatment and specialist follow-up, most babies achieve excellent visual outcomes. Understanding the risks and the importance of ongoing assessments helps parents take confident steps toward protecting their child’s sight. If your baby was born prematurely or you have concerns about early eye development, consider scheduling an appointment with a paediatric eye specialist to ensure the best possible start for your child’s vision. For expert guidance and comprehensive care, contact Clarity Eye Surgeons today and support your child’s journey toward healthy, lifelong vision.

Author bio

Dr Parth Shah is a director and principal ophthalmologist at Clarity Eye Surgeons in Canberra. With extensive training and experience, he is renowned for his expertise in the field. Dr Shah is dedicated not only to performing successful surgeries but also to patient education. His compassionate approach, combined with technical proficiency, has earned him the trust and gratitude of countless patients. He is a true advocate for eye health and a trusted name in the Canberra ophthalmology community.

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