As Premature Births Rise In India, Why Retinopathy Of Prematurity Demands Attention; 6 Questions Every Parent Must Ask

But as more premature babies survive, a new challenge has come into sharper focus, the risk of Retinopathy of Prematurity. The condition is a direct consequence of early birth, when the retina is still developing and vulnerable to disruption. Once confined to neonatal intensive care units, ROP is now recognised as a growing public health concern. It progresses quickly, shows no early outward signs, and can cause irreversible blindness if missed in the critical first weeks of life.

It is estimated that approximately 150,000 infants in India are at risk for Retinopathy of Prematurity (ROP) each year, and of those, about 32.6% of preterm infants screened in some studies are found to have the condition. While an exact number for 2025 isn’t available, this risk-based estimate suggests a high number of infants are affected, with the potential for severe outcomes in some cases.

What Is Retinopathy of Prematurity?

Retinopathy of Prematurity, or ROP, is a disorder of the retinal blood vessels that primarily affects babies born too early. In full-term infants, the network of retinal vessels completes its development in the final weeks of pregnancy. When a child is born prematurely, that development is interrupted.

According to Dr Kalpa Negiloni, Head of Clinical Research at Remidio, “Retinopathy of Prematurity is a retinal vascular disorder that affects premature and low birth weight infants. Normal retinal blood vessel growth continues until full term, but in preterm babies this process is interrupted.”

When premature birth is paired with unstable oxygen levels or medical complications, retinal vessels can grow abnormally. These delicate vessels may leak, scar, or pull on the retina, sometimes causing detachment and blindness. The scale is stark. Nearly 15 million preterm infants are born globally each year, and about 31.9 percent develop some stage of ROP.

More than 50,000 children worldwide are blind from a condition that is largely preventable. In India, fewer than 200 ophthalmologists are trained in ROP management, leaving large regions without specialist care. The condition is most common in middle-income countries where preterm survival has improved, but access to expert screening has not kept pace.

Common Myths That Still Mislead Parents on Newborn Care

Parents often miss early screening opportunities because of misconceptions. Dr Negiloni highlights several persistent myths that can delay diagnosis at the very moment when quick intervention matters most:

• Premature babies are too fragile for an eye examination. In fact, timely retinal screening is safe, routine, and essential.
• If babies open their eyes or react to light, their vision must be fine. ROP advances silently and shows no outward symptoms until late stages.
• Screening can wait for a routine paediatric appointment. ROP can progress to severe damage within weeks, making early checks vital.
• Home remedies or over-the-counter drops can improve vision. They cannot. ROP requires medical evaluation and evidence-based treatment.
• Only extremely premature infants are at risk. Moderate prematurity combined with oxygen fluctuations can still lead to ROP.

Each myth delays screening. Each delay increases the risk of permanent vision loss.

Can Early Detection of ROP Affect Infant Health?

Abnormal blood vessel growth can begin as early as two to three weeks after birth. The window for intervention is narrow, and once retinal damage progresses, the outcomes are often irreversible.

Dr Negiloni who has worked extensively on improving ROP screening across India and other middle-income settings explains, “The first ROP screening should be done no later than 30 days of life and earlier for very low birth weight or critically ill infants. Without screening, the condition can advance rapidly to retinal detachment and irreversible blindness.”

Manual screening is labour-intensive and requires trained paediatric retinal specialists, who are in short supply globally. In India and many similar settings, this scarcity often leads to missed or delayed examinations.

To address this gap, technological innovations are emerging. “Devices such as Neubo 130 use ultra-widefield retinal imaging and AI-based interpretation to assist screening directly in neonatal intensive care units, even in low-connectivity or rural settings,” says Dr Negiloni. This approach allows for quicker triage, early referrals, and wider access to reliable screening.

6 Questions Every Parent Should Ask

Parents do not need medical training to protect their child’s vision. What they need are the right questions at the right time. Dr Negiloni recommends six essential ones:

1. Has my baby been screened for ROP, and when is the next follow-up due?

ROP often progresses between screenings. Parents should track appointment dates as carefully as immunisations.

2. Who will be conducting the eye screening?

Clarifying whether the examiner is a trained ophthalmologist or a screened team member ensures accuracy and safety.

3. Will images of my baby’s eyes be taken?

Imaging supports more reliable detection. It also allows multiple specialists to review the case if needed.

4. How do the retinal images help diagnose ROP?

Images provide a documented baseline and reveal early abnormalities long before symptoms appear.

5. Are the images reviewed with AI tools?

AI-supported evaluation improves early detection in resource-limited settings and reduces the risk of missed cases.

6. If ROP is detected, what stage is it and what treatment is required?

Parents should also ask:

• How soon after treatment should re-examination take place?
• What long-term monitoring will my child need as they grow?
• These questions ensure that the child remains under consistent, informed care.

Is There Treatment For Retinopathy of Prematurity?

Treatment varies with the stage of ROP, but timing is everything. Early stages are usually managed with laser therapy, the most established approach. Some babies may need intravitreal injections to slow abnormal vessel growth, while advanced cases involving retinal detachment can require surgery. All of this works best when done promptly and under the care of specialists trained in neonatal retinal conditions.

Parents often assume that if their baby is stable, feeding well, and gaining weight, the eyes must be fine. ROP does not follow these cues. It does not cause redness, watering, or pain in early stages. It does not announce itself.

This is why paediatricians and ophthalmologists repeatedly stress the same message: ROP is preventable, but only when screening is timely and follow-ups are never missed.