Retinopathy of Prematurity (ROP) Program

The Retinopathy of Prematurity Program at Boston Children's Hospital provides expert screening for premature infants at risk of retinopathy of prematurity (ROP), as well as treatment and follow-up care for those who need interventions.

ROP is an eye condition that affects the developing blood vessels in premature infants’ eyes — particularly those who:

• Are born before 30 weeks of gestation
• Weigh less than 3 lb. 5 oz (1,500 g) at birth
• Need supplemental oxygen or intensive medical support after birth

While ROP is usually mild and often resolves on its own, severe cases can lead to vision loss. Finding and treating ROP early can help protect a baby’s vision and prevent serious complications. Our specialists provide comprehensive care for infants at risk of ROP, ensuring early detection, timely treatment, and tailored follow-up to support each child’s unique needs.

We are recognized for our:

• Comprehensive bedside screenings for infants in the NICU, ensuring early detection and intervention
• Multidisciplinary team of specialists, which includes pediatric ophthalmologists, retina specialists, optometrists, and low-vision experts
• Advanced treatment options, including laser therapy, intraocular injections, and retinal surgeries, provided by highly experienced specialists
• Regional telemedicine screening programs that extend expert care beyond Boston to outlying hospitals in Massachusetts and southern New Hampshire
• Ongoing research and innovation as a clinical research center that advances ROP prevention, screening, treatment, and outcomes through cutting-edge clinical and translational research and multicenter clinical trials.

When a baby is diagnosed with ROP, prompt intervention and specialized care are essential. Our team provides expert and compassionate support, guiding families through management of their child’s eye condition(s). Following national guidelines, we carefully screen and treat infants at risk, ensuring each baby receives the right level of care needed for the best possible vision outcomes.

ROP screening begins in the NICU, where our dedicated nurses and physicians focus on caring for babies with ROP and helping their families understand the condition. If a child’s ROP progresses to a sight-threatening stage, we work closely with their family to explain their treatment plan and provide ongoing support.

To provide the most comprehensive care, our multidisciplinary team works together to deliver both immediate treatment and long-term support for a child’s vision and overall development. The Newborn Medicine Team and Infant Follow up Program are able to quickly coordinate with specialists across departments, such as the Department of Neurology and Division of Developmental Medicine, so infants with complex medical needs receive integrated, specialized care that supports both their visual health and overall development. Within our department, we have over 35 pediatric ophthalmologists and optometrists with expertise to help manage any pediatric eye conditions that can be found in children.

Our program offers advanced, effective treatments for ROP, combining cutting-edge technology with expert care. From innovative imaging techniques to precise surgical interventions, we tailor our treatment plans to every child’s unique needs.

We offer a range of services, from screening and diagnosis to surgical and non-surgical treatments and long-term care and support when needed.

Screening and Diagnosis

Our team conducts bedside evaluations for premature infants in the NICU. This helps us identify problems early and educate families and staff about what to expect and next steps. Babies who have been discharged can be evaluated in an ophthalmologist’s office.

At your child’s evaluation, we may use:

• Dilating eye drops to make their pupils bigger so we can see inside their eyes
• An eyelid speculum, which gently holds the eyelids open
• A scleral depressor to help move the eye into different positions so the doctor can check all parts of the retina
• An indirect ophthalmoscope, which shines a light into the eye, allowing the doctor to look at the retina more closely
• Retinal imaging, which is often performed and allows other providers and parents to see how their child’s eyes are progressing with regard to ROP status. We have state-of-the-art digital imaging systems that allows for high-resolution photography of the retina, improving early detection, diagnosis, and monitoring of ROP progression.

For babies who aren’t being treated in our NICU, we also offer telemedicine screening program that connects with hospitals across the region. This allows us to extend our expert care, making sure premature infants receive the timely evaluations and treatments they need for the best possible outcomes.

Surgical and non-surgical treatment options

• Laser therapy is a standard treatment used to treat the peripheral retina, which helps the abnormal blood vessels in the retina heal, reducing the risk of retinal detachment and vision loss.
• Anti-VEGF injections, which involves injecting a medication into the eye to block VEGF (vascular endothelial growth factor), a protein that promotes abnormal blood vessel growth. This treatment is often combined with laser therapy at a later date to ensure good long-term outcomes.
• Vitrectomy, a surgical procedure where our specialists remove the gel-like substance inside the eye. This helps reduce traction on the retina, preventing further retinal damage and helps retinal reattachment in advanced cases of ROP.
• Scleral buckling, which involves placing a silicone band around the eye to help the retina re-attach to the wall of the eye, or to reduce the risk of detachment.

Long-term care and support 

After treatment, we continue to monitor infants to track their visual development and intervene when necessary. Our follow-up care ensures that children receive the evaluations, therapies, and interventions they need to support their best possible vision outcomes.

Our program is at the forefront of research and innovation to improve the diagnosis, treatment, and long-term outcomes for infants with ROP. As a clinical research center for ROP, we are actively involved in advancing care through pioneering studies and trials. This allows us to offer patients access to the latest treatments, contribute to national guidelines, and collaborate with leading experts to improve long-term outcomes.

Key areas of our clinical research and innovation efforts include:

• Preventing ROP – Researchers at Boston Children’s have investigated, and continue to investigate, ways to prevent ROP from developing in children born early. Our team has collaborated with neonatologists to regulate oxygen supplementation, dietary supplements, and topical eyedrops to see if severe ROP can be prevented.
• Predictive risk scoring – Our researchers have contributed to the development of a predictive risk scoring tool that helps clinicians identify infants most likely to require treatment, enabling earlier and more targeted screening. We have also participated in studies that help identify risk factors for ROP progression that can be observed during interpretation of retinal imaging.
• Treating ROP – Our physicians are trained to provide both laser therapy and ocular injections for treatment for ROP. Our researchers were among the first the demonstrate efficacy of anti-VEGF treatments for ROP, and we continue to study new ways to prevent and treat ROP through translational research programs.

Through these and other efforts, we remain committed to transforming ROP care, improving early detection, expanding access to treatment, and advancing therapies that enhance vision outcomes for premature infants.

To learn more about our ongoing research, visit our Research & Innovation page or explore the Smith Lab's ROP research page.