Skip to content
How It Works
Explore
Resources Ask a Question
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Ask a Question
PubMed This is a summary of 16 peer-reviewed journal articles Updated
Neonatology

The Screening Roadmap: How and When ROP is Detected

At a Glance

Premature babies born at 30 weeks or earlier, or weighing 1,500 grams or less, require carefully timed ROP screenings to prevent vision loss. These bedside eye exams typically begin at 4 weeks of age to closely monitor developing retinal blood vessels.

Because the blood vessels in a premature baby’s eyes are still developing, regular monitoring is the most critical tool doctors have to prevent vision loss [1][2]. While it can be stressful to see your baby undergo medical procedures, these screenings are carefully timed to catch any abnormal growth before it becomes a threat [1][2].

Who Receives Screening?

Not every baby in the NICU requires ROP screening. Expert guidelines from the American Academy of Pediatrics (AAP) and the American Academy of Ophthalmology (AAO) specifically identify infants at the highest risk [1].

Your baby will be screened if they meet either of these criteria:

  • Birth Weight: They weigh 1500 grams (about 3.3 lbs) or less at birth [1][3].
  • Gestational Age: They were born at 30 weeks or earlier [1][3].

In some cases, a neonatologist may order screening for a baby who is slightly larger or older if they have had a particularly unstable medical course, such as severe infections or prolonged needs for high levels of oxygen [1][4].

Timing the First Exam

The timing of the first exam depends on two different ways of measuring your baby’s age:

  • Chronological Age: The number of weeks since your baby was actually born.
  • Postmenstrual Age (PMA): Your baby’s gestational age at birth PLUS the number of weeks since they were born (e.g., a baby born at 26 weeks who is now 5 weeks old has a PMA of 31 weeks) [5][1].

The first exam typically happens at 4 weeks of chronological age or at 31 weeks PMA, whichever is later [1][6]. Your doctor may adjust this slightly based on exact birth weeks. This ensures the doctor checks the eyes just as the blood vessels are reaching a critical stage of development.

What Happens During the Procedure?

The exam is performed at the bedside in the NICU by a pediatric ophthalmologist. While the procedure is brief, it involves several steps to ensure the doctor can see the entire retina:

  1. Dilation: About 30 to 60 minutes before the exam, a nurse will place special eye drops in your baby’s eyes to enlarge (dilate) the pupils. These drops may sting briefly when they go in, which is a normal reaction [7][8].
  2. Numbing: The doctor will use anesthetic drops to numb the surface of the eye [9].
  3. The Speculum: To keep the eye open during the brief exam, a very small, gentle tool called a lid speculum is used [10][11].
  4. The Light and Lens: The doctor uses a bright light (worn on their head) and a hand-held lens—a technique called indirect ophthalmoscopy—to look at the blood vessels [10][11]. They may also use a small probe to gently rotate the eye to see the far edges of the retina [10].

Your Role and Comfort Measures: To minimize stress, the team may give the baby oral sucrose (sugar water), use a pacifier, or perform “facilitated tucking” (holding the baby in a curled, secure position) [9][12]. If you are present, ask the team how you can help. Sometimes you can hold your baby’s hand or offer a pacifier. If you feel faint or overwhelmed, it is completely acceptable to step out of the room during the exam.

Frequency of Follow-Ups

ROP can change quickly, so one exam is rarely enough. The ophthalmologist will decide how often to return based on what they see [1].

  • Weekly or more: If there are signs of rapid change or “plus disease” (where vessels become twisted and swollen) [1][13].
  • Every 2 weeks: If the ROP is mild or just beginning to show [1].
  • Ending Exams: Screening only stops when the blood vessels have reached the edge of the retina (full vascularization) or the ROP has clearly moved into a safe, regressing state [1][14].

Consistency is the key to safety. Even if your baby is discharged from the NICU, you must keep all scheduled outpatient eye appointments to ensure their vision remains protected [15][16].

Common questions in this guide

Which premature babies need to be screened for ROP?
Babies born weighing 1,500 grams or less, or those born at 30 weeks gestation or earlier, require regular screening. Your neonatologist may also order screenings for slightly larger or older babies if they have had severe infections or prolonged high oxygen needs.
When will my baby have their first ROP eye exam?
The first eye exam usually occurs at 4 weeks of chronological age or 31 weeks postmenstrual age, whichever is later. This specific timing ensures the pediatric ophthalmologist checks the eyes right as blood vessel development reaches a critical stage.
Will the ROP screening exam hurt my baby?
The care team takes several steps to minimize discomfort and stress. They use numbing eye drops, and may provide oral sucrose (sugar water), a pacifier, or use a comforting swaddle technique called facilitated tucking during the procedure.
How often will my baby need ROP follow-up exams?
Follow-up frequency depends entirely on what the doctor sees during the exam. Screenings may happen weekly if there are rapid changes, or every two weeks for mild cases, continuing until the blood vessels fully develop or the condition regresses.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my baby's birth weight and gestational age, when is the first eye exam scheduled?
  2. 2.What stage and zone were identified during today's exam, and what does that mean for our next steps?
  3. 3.What pain management methods, such as oral sucrose or specialized swaddling, will be used to keep my baby comfortable during the procedure?
  4. 4.Will the exam be done using a manual light and lens, or will digital imaging be used to document the findings?
  5. 5.If the exam shows that the ROP is progressing, how will the frequency of these visits change?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    Screening Examination of Premature Infants for Retinopathy of Prematurity.

    Fierson WM, , , et al.

    Pediatrics 2018; (142(6)) doi:10.1542/peds.2018-3061.

    PMID: 30478242
  2. 2

    Retinopathy of Prematurity: Evolving Treatment With Anti-Vascular Endothelial Growth Factor.

    Hartnett ME

    American journal of ophthalmology 2020; (218()):208-213 doi:10.1016/j.ajo.2020.05.025.

    PMID: 32450064
  3. 3

    A safety review of drugs used for the treatment of retinopathy of prematurity.

    Filippi L, Dal Monte M

    Expert opinion on drug safety 2020; (19(11)):1409-1418 doi:10.1080/14740338.2020.1826927.

    PMID: 32954858
  4. 4

    A Study of the Demographic Profile, Screening, and Management of Patients Visiting a Retinopathy of Prematurity Clinic.

    Mushtaq I, Agrawal T, Bhavsar D, et al.

    Cureus 2024; (16(4)):e58305 doi:10.7759/cureus.58305.

    PMID: 38752079
  5. 5

    Factors influencing the timing of complete retinal vascularization in infants screened for retinopathy of prematurity.

    Kuziel J, Strampe M, VandeLune J, et al.

    Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2025; (29(6)):104659 doi:10.1016/j.jaapos.2025.104659.

    PMID: 41067499
  6. 6

    Validation of the postnatal growth and retinopathy of prematurity (G-ROP) screening criteria in a Thai cohort.

    Trinavarat A, Najmuangchan N, Ngerncham S, et al.

    Japanese journal of ophthalmology 2023; (67(4)):387-395 doi:10.1007/s10384-023-01003-9.

    PMID: 37341847
  7. 7

    Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study.

    Alpay A, Canturk Ugurbas S, Aydemir C

    BMC pediatrics 2019; (19(1)):415 doi:10.1186/s12887-019-1757-3.

    PMID: 31690284
  8. 8

    Combination of 5% phenylephrine and 0.5% tropicamide eyedrops for pupil dilation in neonates is twice as effective as 0.5% tropicamide eyedrops alone.

    Lux AL, Degoumois A, Barjol A, et al.

    Acta ophthalmologica 2017; (95(2)):165-169 doi:10.1111/aos.13175.

    PMID: 27519933
  9. 9

    Intranasal dexmedetomidine reduces pain scores in preterm infants during retinopathy of prematurity screening.

    Ozkan Zarif N, Arayici S, Celik K, et al.

    Frontiers in pediatrics 2024; (12()):1441324 doi:10.3389/fped.2024.1441324.

    PMID: 39156022
  10. 10

    Avoiding use of lid speculum and indentation reduced infantile stress during retinopathy of prematurity examinations.

    Mataftsi A, Lithoxopoulou M, Seliniotaki AK, et al.

    Acta ophthalmologica 2022; (100(1)):e128-e134 doi:10.1111/aos.15085.

    PMID: 34939742
  11. 11

    Circumferential retinal hemorrhages after ophthalmic examination with scleral depression in an infant with anti-VEGF treated retinopathy of prematurity.

    Hussain RM, Tran KD, Prakhunghunsit S, et al.

    Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2019; (23(5)):293-295 doi:10.1016/j.jaapos.2019.05.002.

    PMID: 31145988
  12. 12

    Analgesia for retinopathy of prematurity screening: A systematic review.

    Thirunavukarasu AJ, Hassan R, Savant SV, Hamilton DL

    Pain practice : the official journal of World Institute of Pain 2022; (22(7)):642-651 doi:10.1111/papr.13138.

    PMID: 35703418
  13. 13

    Characteristics of Eyes Developing Retinal Detachment After Anti-vascular Endothelial Growth Factor Therapy for Retinopathy of Prematurity.

    Kondo C, Iwahashi C, Utamura S, et al.

    Frontiers in pediatrics 2022; (10()):785292 doi:10.3389/fped.2022.785292.

    PMID: 35463897
  14. 14

    Clinical feature and predictive factor analysis for spontaneous regression of retinopathy of prematurity in a Chinese population.

    Li YA, Zhou XH, Cai XJ, Yang CH

    International journal of ophthalmology 2022; (15(12)):1978-1984 doi:10.18240/ijo.2022.12.13.

    PMID: 36536972
  15. 15

    Caregiver Impact and Understanding of Retinopathy of Prematurity Screening.

    Song W, Hui M, Khitri M, et al.

    Journal of patient experience 2025; (12()):23743735251383261 doi:10.1177/23743735251383261.

    PMID: 41049119
  16. 16

    Knowledge, Attitudes and Practices of Health Workers and Caregivers Towards Retinopathy of Prematurity in Uganda: A Mixed-Methods Study.

    Lusobya RC, Atukunda I, Semulimi AW, et al.

    Public health challenges 2024; (3(3)):e208 doi:10.1002/puh2.208.

    PMID: 40496533

This guide provides general educational information about ROP screening schedules and procedures. Always consult your NICU care team and pediatric ophthalmologist for your baby's specific screening timeline and care plan.

Get notified when new evidence is published on Retinopathy of prematurity.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.