Retinopathy of Prematurity Ophthalmologic Approach Workup

Updated: Sep 21, 2023
  • Author: Mounir Bashour, MD, PhD, CM, FRCSC, FACS; Chief Editor: Donny W Suh, MD, MBA, FAAP, FACS  more...
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Imaging Studies

In a 2014 case series of 36 eyes in 18 neonates with ROP, Hariharan and colleagues found that fluorescein angiography was better than standard digital imaging for monitoring infants treated with intravitreal bevacizumab. [16, 17] Precisely detailed advanced vascular growth could be seen with fluorescein angiography for all eyes, whereas digital fundus photography and clinical examination did not reveal subtle changes in vasculature as clearly.

The angiography protocol involved administration of an intravenous bolus of a 10% solution of sodium fluorescein dye, followed by a saline flush. [16, 17] Clinical fundus photography and fluorescein angiography were performed at the time of injection and photography was repeated 2 to 3 weeks after the injection.

In 2008, a telemedicine study showed that single-image and multiple-image telemedicine examinations perform comparably in the determination of a recommended follow-up interval and in the detection of plus disease. [18] In the future, there will likely be an increase and development of screening protocols, particularly in areas with limited access to ophthalmic care. [18]



A dilated fundus examination with scleral depression is necessary. The instruments used are a Sauer speculum (to keep the eyes gently open), a Flynn scleral depressor (to rotate and depress small eyes), and a 28-diopter lens (for proper identification of zones).

The first part of the examination should be external, with identification of iris rubeosis, if present. The next part of the examination should be the posterior pole, with identification of any plus disease or straightening of the vascular arcades. The eye is rotated to identify the presence or absence of zone 1 disease (if the ridge and the optic nerve are present in the same view, this usually implies zone 1). If the nasal vessels are not at the nasal ora serrata, this is still zone 2. If the nasal vessels have reached the nasal ora serrata, the eye is in zone 3.