Professor Armin Wolf:

We know from various studies that there are risk factors for developing ROP in preterm infants. However, we know very little about the long-term consequences as these children grow older. That’s why there is a screening program in place until the infant reaches normal gestational age. After that point, follow-up is recommended based on the findings.

If we look at sequelae occurring in adulthood, they don’t necessarily depend on whether the patient was treated during the critical ROP phase. That said, we also have to consider that ROP treatments have evolved significantly over the past 40 years. So, continued research on long-term outcomes—often referred to as "adult ROP"—is still very much needed.

Professor Armin Wolf:

According to current German ROP screening guidelines, continuous follow-up is recommended after the infant reaches normal gestational age, particularly for preterm children with a birth weight under 1500g or a gestational age under 32 weeks.

For those born between 32 and 36 weeks, regular eye exams are advised until age 6. However, every eye—and every patient with ROP—is different, so follow-up should be individualized. If there are additional health concerns, the monitoring intervals may need to be shorter, as it is not always easy to assess the retinal condition.

With the advent of new medical treatments, we’ve seen rare cases of late ROP reactivation, which makes identification and follow-up critical. Currently, we have very limited data on long-term outcomes of ROP patients. We do know that they are at higher risk for conditions like retinal detachment, glaucoma, and other ocular pathologies. Still, we lack enough data to draw firm conclusions.

What does seem clear is that an eye that has gone through the active phase of ROP, regardless of treatment, remains a “special eye”—even in the context of future treatments. Therefore, it's essential for a treating surgeon to know that a patient was born preterm, as birth weight also plays a role in determining individual risk.

Professor Armin Wolf:

Generally speaking, these examinations focus on the same structures that are checked during the active phase of ROP in the NICU. During the exam, the pupil is dilated and the fundus (the back of the eye) is examined.

Most of these patients are already used to ophthalmic exams, so a standard eye exam at the ophthalmologist's office is usually sufficient. Only in a few cases, or if a potentially significant finding is detected during the standard exam, the procedure must be done under general anesthesia to rule out serious concerns.

Routine exams also include testing visual acuity, measuring refraction (to determine the glasses prescription), and assessing whether there’s a need to patch one eye to ensure balanced development of both eyes.

Invasive procedures are generally not necessary.

Professor Armin Wolf:

In general, these follow-up exams can be performed by any ophthalmologist. However, if the ophthalmologist feels uncomfortable or if there is a history of ROP, referral to a retina specialist or a specialized center may be a good idea.

Professor Armin Wolf:

We tend to focus on ROP patients especially in their early years, when follow-up is mandatory. However, as these children grow older, the fact that they were born preterm is often forgotten, and only a few continue with regular follow-up care into adolescence or adulthood.

I recommend lifelong follow-up, with intervals tailored to the patient’s clinical findings, in order to prevent complications such as retinal detachment. For example, in cases of uncomplicated ROP, I typically schedule annual follow-up exams.

This interview with Professor Armin Wolf was originally conducted and published in 2019. While the medical context remains relevant, newer research or updated guidelines may have emerged since then.