Will My Child Need Glasses After Retinopathy of Prematurity?

Maybe—not every child who had retinopathy of prematurity (ROP) needs glasses, but the risk is significantly higher than for children born full-term ^[1]. The most common reason a child with a history of ROP needs glasses is myopia (nearsightedness) ^[1][2]. Myopia means a child has trouble seeing things that are far away, and while it can be mild, it is often substantial in children who had severe ROP ^[2]. Because the risk is elevated, it is essential for children with a history of ROP to have regular pediatric eye exams throughout childhood, even if their vision seems fine ^[3].

How ROP Severity and Treatment Affect the Risk

The risk of needing glasses is not the same for every child. It depends on several factors, including the severity of the ROP (stage, zone, and presence of “plus” disease) and whether treatment was needed ^[1].

• Mild ROP (Stages 1 and 2): Children whose ROP resolved on its own without treatment have a lower risk of nearsightedness than those who needed treatment ^[4]. However, they still have a higher risk than children born full-term ^[1].
• Severe ROP: The more advanced the ROP, the more likely a child is to develop myopia ^[1]. For example, in one study of infants, nearly 60% of those with aggressive posterior ROP (a distinct, rapidly progressing pattern in the back of the retina) developed nearsightedness ^[1]. It is important to know that ROP severity is not just about the “stage.” The zone (location) and the presence of “plus disease” (abnormally twisted blood vessels) also determine the risk and the need for treatment ^[1].
• Laser Treatment: Children who received laser therapy to treat their ROP have a high observed risk of developing myopia, which is often severe ^[2][5]. Laser treatment helps stop abnormal blood vessels from growing and reduces the risk of retinal detachment, but the combination of the treatment, the extreme prematurity, and the severe disease itself all contribute to changes in how the eye grows, frequently resulting in nearsightedness ^[2].
• Anti-VEGF Injections: Some children are treated with anti-VEGF, a medicine injected into the eye that blocks a signal driving abnormal blood-vessel growth. Children treated with anti-VEGF generally have a lower average risk of early severe myopia compared to those who had laser treatment, though the risk is still present ^[5][6]. However, after anti-VEGF treatment, the ROP can sometimes reactivate months later, meaning these children often require prolonged and careful retinal surveillance ^[7][8].

Other Vision Conditions to Watch For

In addition to nearsightedness, children who had ROP are at higher risk for other vision conditions that might require glasses, patching, or other treatments ^[9][10]:

• Astigmatism: An imperfection in the curvature of the eye that causes blurred or distorted vision ^[9].
• Anisometropia: This happens when the two eyes have significantly different vision prescriptions, meaning one eye focuses much better than the other ^[10].
• Strabismus (Crossed or Wandering Eyes): A condition where the eyes do not properly align with each other ^[11].
• Amblyopia (Lazy Eye): This occurs when the brain starts to ignore the vision from one eye, often because it is blurrier than the other or because the eyes are not aligned ^[11]. Needing glasses is a common and important part of treating amblyopia to support healthy visual development ^[3].

The Importance of Long-Term Eye Exams

When the acute phase of ROP passes and the neonatal intensive care unit (NICU) eye specialist determines that screening for active ROP is complete, the child’s eye care journey is not over ^[3]. It is important to have a seamless handoff to a pediatric ophthalmologist for long-term monitoring, as there is no single schedule that applies to all children ^[3].

These regular exams are critical because young children rarely complain about their vision—they do not know what “normal” vision is supposed to look like. Early childhood eye exams use special dilating drops that more accurately measure refractive error (the glasses prescription), even before a child can read an eye chart ^[12]. Relying solely on routine school or pediatrician vision screenings is often not enough for children with a history of ROP.

Furthermore, lifelong monitoring of the retina is sometimes advised ^[13]. In some children and adults with a history of ROP, the edges of the retina remain without normal blood vessels, a condition called persistent avascular retina ^[14][12]. While not every such area will develop a problem, years or even decades later, it can sometimes lead to complications like retinal tears or retinal detachment ^[15][13].

When to Seek Urgent Care:
If your child is older and can report symptoms, or if you notice sudden changes, seek urgent eye care for:

• A sudden increase in eye floaters or new flashes of light ^[16].
• A shadow or “curtain” coming down over their vision ^[15].
• Sudden vision loss or a persistent, sudden change in how they use an eye ^[15].