KIDROP was India’s first tele-ROP program and is currently one of the largest single-center ROP programs in the world. In all, 127 NICUs across the state of Karnataka (Government and Private) are covered each week. Over 150,000 screening sessions have been completed and over 2500 babies treated thus far. This program is a public-private partnership with the Government of Karnataka and has mentored other ROP programs across the country. KIDROP has received several awards nationally and internationally for its innovations, including Public-Private Partnership of the Year in 2012, National Award for Excellence in HealthCare in 2016, K R Datta Award for Community Outreach in 2017, and BIRAC Innovator Award for HealthCare in 2018.

Narayana Nethralaya is equipped to perform ROP treatments of all forms with ease in new-borns and young children thanks to a dedicated, state of art Pediatric eye surgery operating room. We are the first and only center to use OCT imaging to monitor infants for ROP and vision development – including CVI and poor vision. Our ROP specialists care for hundreds of infants with ROP each year and will discuss your child’s treatment options in detail with you.

Risk factors for developing Retinopathy of Prematurity (ROP)

The two biggest risk factors for developing ROP are premature birth (most common in babies born more than 12 weeks early) and a low birth weight (most common in 11% – 56% of preterm infants with low birth weight). A baby’s eyes develop the most during the last 3 months of pregnancy in the womb. When a baby is born early, the development of the retina is incomplete and there is a risk that the blood vessels which supplyoxygen to the eye may not grow normally, which can lead to ROP.

Other than premature birth and low birth weight, many other factors can place these babies at higher risk of ROP. This includes prolonged use of oxygen (for their lungs), sepsis (blood infection), blood transfusion, jaundice, low weight gain, low platelets, anaemia (low haemoglobin), intraventricular haemorrhage (bleeding in the brain), etc.

If your baby was born premature, you may have concerns about ROP affecting your child’s vision. Narayana Nethralaya recommends an ROP screening a few weeks after delivery (first screening before 30 days after birth or earlier) for premature babies and babies that weigh less than 2 kgs at birth, and before they are discharged from the hospital. Timely diagnosis and early treatment can improve the chances of preserving vision.

Signs and Symptoms of Retinopathy of Prematurity (ROP)

The retina is responsible for one’s vision and any damage to it can lead to vision loss or blindness. Sadly, there are no visible signs of ROP externally when it first develops in a new-born. As a result, many parents do not get their babies screened on time. In advanced stages of ROP, there is a white reflex (leukocoria) in the center of the pupil (round black portion of the eye). Unfortunately, by the time there are signs (when the baby is 4 – 6 weeks old) it is too late to save useful vision. An untreated infant with advanced ROP will have poor vision, poor eye contact with the parent, abnormal shaking of the eyes (nystagmus), and often delayed milestones as well.

Subtle changes in a baby’s retina can only be detected by a Pediatric retinal (ROP) specialist during an eye test where the baby’s retina is examined using special instruments. Narayana Nethralaya recommends an ROP screening for all preterm infants shortly after birth and once again before they go home from the hospital. Our paediatric retina team is trained to detect ROP before it becomes severe enough to result in retinal detachment.

Stages of Retinopathy of Prematurity (ROP)

The severity of ROP is graded into stages, from stage 1 to stage 5, with stage 1 being the mildest and stage 5 the most severe.

• Stage 1 – This is the mildest form of ROP with slight abnormal blood vessel growth.
• Stage 2 – Moderate abnormal blood vessel growth is seen in this stage.
• Stage 3 – This is a critical stage with severe abnormal blood vessel and tissue growth which can lead to bleeding, swelling, and leakage in the retina.
• Stage 4 – At this stage, the retina starts to move from its normal position (detachment), first at the edges (retinal periphery), and then in the visual center (macula).
• Stage 5 – This is the end stage of the disease where the retina is completely detached. Severe vision problems or even blindness is likely at stage 5.

Another form of severe ROP is the ‘Aggressive Posterior ROP’ (called APROP) where stages 1 to 3 are skipped and it goes directly to stages 4 and 5. These cases are the most difficult to diagnose and treat.

The Pediatric retina department at Narayana Nethralaya offers therapeutic intervention for all stages of retinopathy of prematurity (ROP). Our team is trained to identify ROP in preterm babies and will recommend the proper treatment to ensure that the baby’s vision is safeguarded.

Retinopathy of Prematurity (ROP) screening

The purpose of ROP screening in premature infants is early detection of the condition so that it can be treated effectively to prevent vision loss. Doctors cannot predict which preterm baby will develop ROP as there are no visible signs or symptoms of the condition in the early stages, therefore screening is crucial. In India, the national ROP guidelines (2018) recommend that all babies born less than 2000 grams and/or premature (less than 34 weeks of gestation), must undergo their first ROP screening before they are 30 days old.

 All premature infants should be monitored for ROP even after discharge from the hospital, as the condition is not always evident immediately after birth. Special imaging equipment is used by our team to screen the premature infant either in the NICU at the maternity hospital or at our hospital if the baby has already been discharged. If any signs of ROP are present, our ROP specialists will schedule follow-up exams to monitor the baby’s condition and determine when treatment is needed.

Diagnosis of Retinopathy of Prematurity (ROP)

ROP needs to be diagnosed by an ophthalmologist who is trained in ROP management. The Pediatric Retina department at Narayana Nethralaya is equipped with the most up-to-date technology to detect ROP in preterm infants. Our ophthalmologists are trained in the diagnosis of ROP and will carefully examine the inside of your preterm infant’s eyes for any abnormalities in the retina. The examination only takes a couple of minutes and will not hurt the baby. 

Here is what you can expect:

• Eye drops are used to dilate (enlarge) the baby’s pupils so that the retina can be studied.
• Aspecially designed eyelid speculum is used to hold the eyelids open.
• Aviewing instrument called an indirect ophthalmoscope, which has a special lens that sends a bright light into the eye, is used by the specialist to examine the retina and retinal blood vessels.
• A special camera (RetCam or Neo) is used to take high-resolution digital pictures of the retina. This provides detailed images that help in the follow-up of the progress of the baby’s condition over time.

If any signs of ROP are detected, the doctor will discuss the follow-up evaluations and treatment options with you.

Treatment of Retinopathy of Prematurity (ROP)

Treatment will depend on the stage and severity of ROP. In most babies, ROP is mild and resolves on its own without treatment, causing no damage. However, infants with more severe forms of ROP will require treatment to reduce the chances of retinal detachment and permanent vision loss or blindness. ROP that requires treatment is called ‘Type 1 ROP’ and must be ideally treated within 48 hours of the diagnosis for the best outcome. ROP treatment is commonly done with a special ROP laser under topical anaesthesia (eye drops) by a specialist, where the part of the retina which has not received blood supply is treated. 90% of babies respond well to laser treatment and the ROP disappears and sight is preserved. Other than laser, injections into the eye (intravitreal) of a drug that can reverse the abnormal vessel growth are also used in certain conditions. Many of the babies who receive injections will also require laser later. Advanced stages of 4 and 5 will require retinal surgery under general anaesthesia and NICU support.

If treatment is not given on time, the child can become blind or severely visually impaired in both eyes permanently. In some infants, Stage 1 or 2 ROP will worsen to Stage 3 or higher. The success after the treatment of stage 5 ROP is very poor even after surgery.

Narayana Nethralaya is equipped to perform ROP treatments of all forms with ease in new-borns and young children thanks to a dedicated, state of art Pediatric eye surgery operating room. We are the first and only center to use OCT imaging to monitor infants for ROP and vision development – including CVI and poor vision. Our ROP specialistscare for hundreds of infants with ROP each year and will discuss your child’s treatment options in detail with you.

KIDROP – Patient Process Flow

If your child had a premature birth(born more than 12 weeks early) and/or had a low birth weight (less than 2 kgs) and has not been screened for ROP in the NICU, you should schedule an appointment with our pediatric retina specialist to get the infant’s eyes checked immediately. Your initial consultation with the doctor will approximately take 2 hours if you do not require cross-consultation and up to 4 hours if you require cross-consultation. During your consultation, our doctors and counsellors will determine the best course of action for your infant’s visual needs, go over the risks and benefits of treatment, and help you choose the best procedure that is suitable for preserving and improving the child’s vision.