Can ROP Cause Long-Term Eye Problems After It Resolves?

If your baby’s retinopathy of prematurity (ROP) went away on its own without needing laser or injection treatments, this is excellent news. For most babies with mild, resolved ROP, the long-term outlook for vision is very favorable. However, spontaneous resolution does not mean your child no longer needs specialized eye care. Even when mild ROP resolves naturally, prematurity itself—combined with a history of ROP—means your child has a higher risk for certain eye and vision problems compared to children born at term. Ongoing monitoring is important to catch and treat these issues early.

Why Follow-Up Care is Still Needed

While the abnormal blood vessels associated with ROP may have stopped growing and faded away, being born prematurely affects how the eye develops. The specific risks depend on how prematurely your baby was born, their overall health in the NICU, and the stage or location of their ROP.

Nearsightedness (Myopia) and Refractive Errors

Children born prematurely, particularly those with a history of ROP, have a higher chance of developing refractive errors—most commonly nearsightedness (myopia)—than children born at term ^[1][2]. In some studies of premature infants, up to 30% of those whose ROP resolved on its own developed nearsightedness by age one ^[2]. Astigmatism (an irregular curve of the eye) and anisometropia (a significant difference in prescription between the two eyes) are also more common ^[3]. These statistics are population estimates, not a guarantee of your child’s outcome, but they highlight why monitoring is crucial. Because infants cannot tell you that their vision is blurry, regular eye exams are the most reliable way to catch and correct these issues with glasses before they affect learning and development.

Crossed Eyes (Strabismus) and Lazy Eye (Amblyopia)

Premature infants are also at a higher risk for strabismus (misaligned or crossed eyes) and amblyopia (lazy eye) ^[4]. Studies have observed strabismus in roughly 20% of children born prematurely with a history of untreated ROP, compared to around 6% of children born full-term ^[5].

If an eye is misaligned (strabismus) or has a high refractive error, the brain may start to ignore the blurry input from that eye. This reduced visual development is called amblyopia. Strabismus may be treated with glasses or surgery. Amblyopia is often treated by wearing an eye patch over the stronger eye to force the brain to use the weaker “lazy” eye. Early detection makes these treatments highly effective, but they rely on consistent screening.

Incomplete Blood Vessel Growth (Persistent Avascular Retina)

Even when ROP is considered “resolved,” it doesn’t always mean the retina is perfectly mature. Sometimes, the normal blood vessels never fully reach the very edges of the retina, a condition called persistent avascular retina ^[6][7]. In one study of school-aged children whose ROP resolved on its own, about one-third still had areas of the retina without blood vessels ^[6].

While this is often harmless and the long-term risks are still being studied, incomplete vascularization can sometimes increase the risk of retinal tears later in life ^[7][8]. Your eye doctor will decide if special ongoing monitoring is needed based on your child’s specific retinal health.

What to Expect Next

Because vision problems can develop gradually, your child’s care team will recommend a follow-up schedule. A common recommendation is to schedule a comprehensive eye exam 4 to 6 months after your baby’s final acute ROP screening exam ^[9][10]. However, this timeline should be individualized based on your baby’s gestational age, how completely their retinal blood vessels grew, and any other medical factors.

It is important to know that a routine vision screen at your pediatrician’s office is very valuable, but it does not replace a dilated eye exam from a pediatric ophthalmologist (a medical eye specialist for children). During these specialized exams, the doctor will use dilating drops to temporarily enlarge the pupils. This allows them to thoroughly check the health of the retina and accurately measure for a glasses prescription ^[9].

Warning Signs to Watch For

While routine appointments are essential, you should contact your pediatric ophthalmologist earlier if you notice any sudden changes or red flags:

• In infants and toddlers: An eye that consistently turns inward or outward, an abnormal white reflection in the pupil (instead of the typical “red eye” in photos), poor tracking of objects, or unusual jerky eye movements.
• In older children: Complaints of sudden vision loss, new “floaters” (spots in their vision), flashing lights, or a curtain-like shadow over their vision.