What it is
Retinopathy of Prematurity (ROP) is an eye condition that affects premature infants. The retina — the light-sensing layer at the back of the eye — normally finishes developing in the last weeks of pregnancy. When a baby is born very early, that development is interrupted, and abnormal blood vessels can grow in the retina. Untreated in severe cases, they can pull the retina off the wall of the eye and cause blindness.
About 14,000 premature babies are diagnosed with ROP each year in the United States. The encouraging part: with good screening and modern treatment, the vast majority go on to have healthy vision. Dr. Vredevoogd has been screening and treating ROP across West Michigan for over 20 years, with hospital privileges at Zeeland Community, Spectrum Health, and Holland Hospital.
Signs parents notice
ROP has no outward symptoms in its early stages — which is why screening is so important. Only in advanced cases do you see things like unusual eye movements, a whitish pupil, or a baby who doesn't seem to track faces.
If your baby was born under about 1,500 grams (≈3 pounds) or earlier than 30 weeks gestation, the NICU team will arrange a dilated eye exam on a schedule — typically starting 4–6 weeks after birth. Babies with serious respiratory complications may also need screening.
How we diagnose it
Diagnosis is by dilated retinal exam. We use dilating drops, a small lid speculum to hold the eyes open, and an indirect ophthalmoscope to look carefully at the retina. The exam is quick — a few minutes — and safe; we do it in the NICU so the baby never has to travel.
We grade ROP by stage (1–5, based on severity) and zone (how far the abnormal vessel growth extends). Based on the grading, we either watch (most cases), screen more frequently, or move to treatment.
How we treat it
Most mild ROP resolves on its own as the baby grows. Treatment is reserved for severe cases to prevent retinal detachment:
- Laser photocoagulation — we laser the peripheral retina where abnormal vessels are growing, which stops progression. It's the most established treatment and very effective.
- Anti-VEGF injections — medications that block the signal driving the abnormal vessel growth. Useful in specific subtypes and for particularly aggressive cases.
- Surgical intervention — for the rare cases that progress to partial or complete retinal detachment (stages 4–5), vitrectomy or scleral buckle surgery can sometimes save vision.
Treatment decisions are made jointly with the NICU team and with you. The goal is always: do as little as possible to get a good outcome.
What the journey looks like
Screening exams typically happen every 1–3 weeks while the baby is in the NICU, continuing until we see the retinal blood vessels have fully developed (usually around the baby's original due date) or until ROP has regressed. After discharge, we follow up in the office at increasing intervals.
Children who had ROP — even mild, untreated ROP — have higher rates of later-life refractive errors, amblyopia, strabismus, and retinal issues. We stay with them long-term, catching these things early if they come up.
When to call us
- Your baby was born premature (generally under 30 weeks or 1,500 grams) and you want to confirm an ROP screening is on the books
- Your child had ROP as an infant and hasn't had an eye exam recently — they need one
- You notice your former-premie child's eyes drifting, head tilting, or not tracking well as a toddler or older child