Why early eye screening can save premature babies from blindness

As more premature babies survive due to advances in neonatal care, a silent eye condition is emerging as a major threat to their vision. Experts say timely screening and treatment can prevent most cases of blindness caused by Retinopathy of Prematurity (ROP).

In Short

• ROP can silently damage premature infants' retinas and cause irreversible blindness
• India's broader screening criteria include babies up to 34 weeks
• First retinal examination is recommended within the baby's first month

As neonatal care continues to improve across India, more premature babies are surviving than ever before. However, according to Dr Rishi Raj Borah, Country Director, Orbis India, Retinopathy of Prematurity (ROP) has emerged as a growing concern in neonatal intensive care units (NICUs), putting thousands of infants at risk of preventable blindness every year.

ROP affects the retina, the light-sensitive tissue at the back of the eye. It occurs when abnormal blood vessels grow in the retina of premature infants. In severe cases, these vessels can cause retinal detachment, resulting in irreversible vision loss. The most concerning aspect of the disease is that it often develops without any visible symptoms, making routine screening essential.

According to the World Health Organisation (WHO), around 15 million babies are born prematurely every year across the world. The International Agency for the Prevention of Blindness estimates that nearly 32,300 preterm infants globally become permanently blind or visually impaired due to ROP. India, which accounts for one of the highest numbers of preterm births worldwide, faces a particularly heavy burden.

Experts warn that the country is currently experiencing what is often referred to as the "third epidemic" of ROP. This rise is linked to increasing survival rates among extremely premature babies and the rapid expansion of neonatal care services, which are not always matched by adequate screening and monitoring systems. As more vulnerable newborns survive, ensuring their long-term vision has become an urgent public health priority.

WHAT IS RETINOPATHY OF PREMATURITY?

Retinopathy of Prematurity is an eye condition that primarily affects babies born before their eyes have fully developed. The disease occurs when blood vessels in the retina grow abnormally after birth.

In its early stages, ROP may resolve on its own. However, in more severe cases, the abnormal blood vessels can scar and pull on the retina, leading to retinal detachment and blindness.

The condition is especially common among babies born very early or with low birth weight. However, experts say the Indian scenario differs from that seen in many developed countries.

WHY INDIA FACES A UNIQUE CHALLENGE

In Western countries, severe ROP is usually seen in extremely premature infants weighing less than 1,500 grams. In India, however, studies have shown that even babies born after 34 weeks of gestation or weighing up to 2,000 grams can develop sight-threatening ROP.

This broader risk profile means that many more infants require screening. As a result, experts stress that all neonatal facilities must strictly follow Indian screening guidelines, which recommend retinal examinations for babies born at or before 34 weeks of gestation or weighing 2,000 grams or less.

Failure to identify at-risk babies can lead to delayed diagnosis and treatment, significantly increasing the chances of permanent vision loss.

WHY EARLY SCREENING IS CRITICAL

One of the biggest challenges with ROP is that parents may not notice any warning signs. The disease develops silently during the first few weeks after birth, making routine eye examinations the only reliable way to detect it.

Medical guidelines recommend that preterm babies undergo their first retinal screening within the first month of life. Depending on the findings, doctors may schedule follow-up examinations to monitor disease progression.

When detected early, ROP can be effectively treated using laser therapy or anti-VEGF injections, which help stop the abnormal growth of blood vessels.

Doctors emphasise that timing is crucial. Even a short delay in follow-up appointments can allow the disease to progress to advanced stages, where treatment becomes less effective, and the risk of blindness increases dramatically.

GAPS IN SCREENING AND REFERRAL SYSTEMS

Despite growing awareness, significant gaps remain in India's ROP screening and referral systems.

Many NICUs, particularly in smaller towns and rural areas, do not consistently integrate eye screening into discharge planning. As a result, babies may leave the hospital without receiving the necessary retinal examination or follow-up schedule.

Another major challenge is the shortage of trained pediatric ophthalmologists and retinal specialists outside large urban centres. Many healthcare facilities also lack portable retinal imaging devices that can help screen infants in remote locations.

Public health programmes have recognised ROP as an important area of intervention. However, implementation remains uneven across different states, leading to disparities in access to timely diagnosis and treatment.

Experts believe stronger referral networks between district hospitals, Special Newborn Care Units (SNCUs), and specialised eye care centres are essential to reduce preventable blindness among premature infants.

THE ROLE OF PARENTS AND COMMUNITY AWARENESS

Parental awareness plays a crucial role in preventing vision loss from ROP.

Many families are unaware that premature babies require eye screening even after they are discharged from the hospital. Missing a follow-up appointment can have serious consequences because the disease can progress rapidly.

Healthcare workers, including nurses, ASHA workers, and community health staff, can help bridge this gap by educating parents about the importance of retinal examinations and ensuring that babies return for scheduled follow-up visits.

Improved counselling at the time of discharge can significantly increase compliance with screening recommendations and reduce the number of infants lost to follow-up.

BUILDING A STRONGER PREVENTION SYSTEM

Experts say preventing blindness due to ROP requires a coordinated approach involving neonatologists, ophthalmologists, nurses, healthcare administrators, and policymakers.

Routine screening should become a standard component of NICU care across the country. Tele-ophthalmology services and portable retinal imaging technologies can help extend specialist support to underserved regions.

In addition, careful monitoring of oxygen therapy in premature infants is critical. Improper oxygen management is a known risk factor for the development of severe ROP.

Several states in India have already demonstrated that well-coordinated screening programmes can improve early detection and treatment outcomes. Expanding these successful models nationwide could help protect the vision of thousands of vulnerable newborns every year.

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