Stage 5 retinopathy of prematurity: The silent epidemic blinding our smallest babies

Stage 5 retinopathy of prematurity: The silent epidemic blinding our smallest babiesIndia had the highest number of preterm births (3.02 million) in the world in 2020, accounting for over 20% of all preterm births worldwide. [1]Retinopathy of prematurity (ROP) is the most common cause of childhood blindness seen in preterm and low-birth-weight babies, and the third "ROP epidemic" is severely affecting low-and middle-income countries.With timely ROP screening, severe ROP can be detected and treated early with intravitreal anti-VEGF injections, laser therapy, or microincision lens-sparing surgery with excellent outcomes.Stage 5 ROP is the last stage with total retinal detachment, which leads to irreversible blindness. [2]As ROP affects both eyes, it can lead to bilateral blindness.With the rising incidence of assisted reproduction techniques and multiple births, all the siblings might be affected by blinding stage 5 ROP, which is particularly devastating to families.Many babies develop aggressive ROP (AROP), a severe variant that rapidly progresses to stage 5 blinding ROP.Ocular auto-stimulation is also commonly observed (78.5%) in stage 5 ROP-affected babies, leading to enophthalmos, corneal opacity, and posterior synechiae, which is further cosmetically disabling. [3]Often these preterm babies are labeled as blind from birth, but it is well known that ROP develops after birth due to multiple systemic risk factors and poor NICU care.