Eye Checks For Premature Babies - Screening For Retinopathy Of Prematurity

Key points about eye checks for premature babies

• a baby who is born early has eyes that are still developing
• very premature babies need eye checks in case they develop a condition called retinopathy of prematurity
• it's important not to miss any babies with this problem

Which babies need eye checks?

The following babies need an eye check to screen for a condition called retinopathy of prematurity (ROP):

• premature babies born before 30 weeks gestation
• all babies weighing less than 1250 grams
• some babies who have been very sick

Sometimes your baby's doctor may want the eye specialist to look at your baby's eye for a reason other than ROP screening. They will discuss this with you.

What is retinopathy of prematurity?

The back part of the eye is called the retina. It receives light from our surroundings and sends visual signals to the brain.

Babies' eyes develop very quickly in the last 12 weeks of pregnancy. A baby born very early has eyes that are still developing. In these babies, there is a risk of the blood vessels of the retina not growing normally. This can cause scar tissue which can pull the retina away from the back of the eye. This is called retinopathy of prematurity (ROP). It can cause severe problems with vision, including blindness if not treated.

When will my baby have an eye check?

The first eye check will happen when your baby is around 4 to 6 weeks old and then every 1 to 2 weeks until the retina has fully developed.

What happens during my baby's eye check?

Your baby will have some eye drops

Your baby will have eye drops in each eye. Because these drops take time to work, your baby will have them about 30 to 60 minutes before their eye check.

These drops will numb the eye and make the pupil bigger (dilated) so that a member of the eye team can look at, or take photographs of the back of the eye.

The effect from the eye drops can last all day. Your baby may be a little unsettled and more sensitive to light. Sometimes, babies can become unwell and may need closer monitoring and support for a few hours.

Your baby's eyelids will need to be held open

During your baby's eye check, a health professional will use a small instrument to hold open your baby's eyelids. This keeps the eyelids out of the way.

Keeping your baby comfortable

Having the drops and holding the eyelids open can be uncomfortable for your baby. You are welcome to stay with your baby during their eye check, and to help. You or the nurse can give your baby expressed breast milk. Or you can give sucrose by mouth to help your baby feel more comfortable. 

A member of the eye team will check the retina

An eye specialist (ophthalmologist) or another member of the eye team will check your baby's eyes.

They may take photographs with a special camera.

The eye check will only take a couple of minutes.

What happens after my baby's eye check?

If your baby had photographs taken, an eye specialist will look at them. This usually happens within 48 hours. If there are any concerns, your baby's doctor will talk to you about these and what will happen next.

What if my baby's eye check shows there is something wrong?

Retinopathy of prematurity (ROP) has different stages.

Mild retinopathy of prematurity

Mild ROP (stages 1 to 2) usually gets better on its own. Your baby will need eye checks until the blood vessels in the eye are fully developed.

When retinopathy of prematurity is more serious

If ROP is more serious, then your baby may need treatment with laser surgery or injections. This reduces the chance of the retina pulling away from the back of the eye. If your baby needs treatment, the eye specialist will talk about this with you. You will have a chance to ask any questions. If your baby does need laser surgery or injections, they may need to go to another unit or hospital.

It is rare for a baby to have severe ROP. But it's important not to miss any babies with this problem. That's why babies need these eye checks.

How often will my baby have eye checks?

Your baby will usually have eye checks every 2 weeks. Babies with serious ROP may need to have eye checks more often.

What happens about eye checks when my baby goes home from hospital?

If the eye specialist is still monitoring your baby's eyes

Your baby will need to go to an appointment for their next eye check. Sometimes this will be at the neonatal or special care baby unit at the hospital. Or it may be at an outpatient clinic. Ask your doctor or nurse before you leave hospital.

If the eye specialist has finished monitoring your baby's eyes

The eye specialist will generally arrange for your baby to have another check when they are between 6 to 36 months old.

This is because premature babies are more likely to develop a squint or need glasses by the time they are 3 years old. If you are ever worried that your baby's eyes do not look straight or if you are concerned about your baby's vision, talk to your family doctor (GP).