Can Adults With ROP Have a Retinal Detachment Later?

Yes, older children and adults who had retinopathy of prematurity (ROP) as babies can experience sudden vision loss, most notably from late-onset retinal detachment ^[1]. A retinal detachment is a serious medical emergency where the light-sensitive tissue at the back of the eye pulls away from its normal position.

Having had ROP does not mean you will inevitably develop a detachment ^[2]. Many adults with a history of ROP enjoy stable vision throughout their lives. However, structural changes left behind by the infant disease mean you have an increased risk that requires individualized, lifelong monitoring ^[3].

Why Does ROP Increase the Risk of Late Detachment?

When a baby is born prematurely, the blood vessels in their eyes have not finished growing. In ROP, these vessels can grow abnormally, leak, and create scar tissue. Even after the disease stabilizes, several underlying factors leave the eye vulnerable years later:

• Persistent Avascular Retina: In some ROP survivors, normal blood vessels never fully reach the outer edges of the retina ^[4]. This “avascular” (lacking blood vessels) tissue can be associated with thinning, holes, and tears later in life ^[5][3].
• Scar Tissue and Traction: Severe ROP often leaves behind microscopic scars. Over time, these scars can physically pull the retina away from the back of the eye (a tractional detachment) ^[6]. Alternatively, the gel inside the eye can pull on weak spots, creating a hole or tear that allows fluid under the retina (a rhegmatogenous detachment).
• High Nearsightedness (Myopia): ROP survivors frequently develop severe nearsightedness ^[7]. Highly myopic eyes are physically longer, which stretches the retina and makes it thinner and more fragile.

Who is at Higher Risk?

While anyone with a history of ROP needs lifelong follow-up, the risk varies substantially. It is highest for individuals who had severe ROP, posterior (zone I) disease, or those who required treatments like laser therapy, cryotherapy (freezing), or anti-VEGF injections (medications that stop abnormal vessel growth) ^[1][8]. These treatments do not cause the risk; rather, needing them is a marker that you had severe disease.

In some uncommon cases, individuals treated with anti-VEGF injections can experience delayed vascular changes or late “reactivation” of the disease years after an initially quiet period ^[8][5].

Late complications can happen at any age. In selected medical case studies of patients who did experience late complications, retinal detachments and vitreous hemorrhages (bleeding inside the eye) often presented at an average age of around 20 years old ^[1][9]. However, because these are averages from high-risk referral groups, they do not mean the danger passes after your 20s. Tears and detachments have been documented well into patients’ 30s, 40s, and beyond ^[1][10].

Warning Signs of Retinal Detachment

Because a retinal detachment can cause permanent vision loss, it is critical to know the warning signs. Keep in mind that some ROP-related detachments develop gradually without symptoms, which is why regular monitoring is vital. However, if you experience any of the following, seek emergency ophthalmic care immediately ^[11][12]:

• New Floaters: A sudden increase in dark spots, squiggly lines, or “cobwebs” drifting across your vision.
• Flashes of Light: Sudden, brief flashes or streaks of light in your side vision, even in a dark room.
• A Shadow or Curtain: A dark shadow or gray curtain appearing over part of your vision, often starting from the periphery (the sides, top, or bottom).
• Sudden Blur or Vision Loss: Any rapid, unexplained decrease in how clearly you can see.

Note: While these symptoms can be caused by less dangerous conditions, you cannot know without an exam. Do not wait for a scheduled appointment. If your eye doctor is unavailable, go to an emergency department or local emergency eye clinic.

The Importance of Lifelong Eye Exams

Because of these risks, graduating from pediatric eye care does not mean you no longer need an eye doctor. Lifelong, periodic comprehensive dilated eye exams are essential ^[2][3]. A standard vision screening for glasses is not enough; your doctor must use eye drops to widen your pupils and thoroughly examine the far edges of your retina for abnormal vessels, scars, and traction ^[3].

Depending on your specific anatomy, your specialist may recommend returning annually, or they may suggest a different schedule tailored to your risk level. In some cases, they may use specialized tools like ultra-widefield photography or fluorescein angiography (an injected dye test that highlights blood flow) to identify microscopic leaks or avascular retina ^[4]. If weak spots or tears are found, preventative laser treatments can sometimes be used to secure the retina, though this is not automatic; your doctor will weigh the risks and benefits of treatment versus careful observation ^[13].