By Dr. Tania Basaiawmoit
Every year, millions of babies enter the world too soon—tiny, fragile, fighting to breathe, and fighting simply to survive. Some fit in the palm of a hand. Some weigh less than a packet of sugar. Many spend their first days and weeks surrounded by blinking monitors, tubes, and the anxious prayers of their parents.
On World Prematurity Day, we are reminded that while survival is the first miracle, thriving is the true goal. And thriving includes protecting something fundamental to a child’s development, learning, bonding, and safety: their vision.
This year’s theme, “A strong start for a hopeful future,” endorsed by the WHO, highlights the need for comprehensive care for preterm and low-birth-weight babies. While nutrition, warmth, respiratory support, and infection control are rightly emphasized, there is one equally vital yet often forgotten aspect of neonatal care: eye care for premature babies.
Because prematurity does not affect only the lungs or the weight of the baby—it can silently, permanently affect the eyes. And if not detected on time, this silent damage can lead to irreversible blindness.
What is Retinopathy of Prematurity (ROP)?
Retinopathy of Prematurity (ROP) is one of the most serious complications associated with premature birth. It affects the retina, the delicate light-sensitive layer at the back of the eye. In full-term babies, retinal blood vessels develop completely inside the womb. But when babies are born too early, this normal development is interrupted.
In response, blood vessels may grow abnormally, sometimes aggressively. They may leak, scar, or pull on the retina. In advanced stages, this can cause the retina to detach—a condition that leads to permanent and irreversible blindness.
One of the most dangerous aspects of ROP is its complete silence in the early stages.
- There is no redness in the eyes.
- No watering.
- No visible discomfort.
- No external warning signs at all.
- To a parent, the baby looks perfectly fine.
Even experienced doctors cannot detect early ROP without proper eye examination equipment. By the time visible signs of blindness appear—such as a white pupil, eye shaking, poor tracking, or lack of response to light—the disease is already far advanced, and treatment is often either difficult or no longer possible.
This is why timely ROP screening is not optional—it is sightsaving.
The Indian Context: A Growing Concern
India has one of the highest numbers of preterm births in the world. Around 1 in every 8 to 10 babies is born prematurely. India alone contributes over 20% of the world’s preterm births. Thanks to improved neonatal care, even very small and extremely premature babies now survive—something unthinkable a few decades ago.
But with this triumph comes a new challenge.
More survival = More babies at risk of ROP.
It is estimated that 500 children in India become blind from ROP every year—a devastating number considering that nearly all of this blindness could have been prevented through timely screening and intervention.
Survival without screening can mean blindness.
Survival with screening can mean sight.
The Situation in Meghalaya: Gaps, Progress, and Hope
Much of India’s available data on ROP comes from urban centres. However, many states—including Meghalaya—have historically lacked structured ROP data due to limited neonatal facilities in earlier years. But this scenario has been changing rapidly.
With more operational NICUs across both government and private hospitals, the survival of preterm babies in Meghalaya has improved significantly. Naturally, this has led to a higher number of infants at risk for developing ROP.
For the last decade, Bansara Eye Care Hospital has been deeply committed to filling this gap. Through the Bansara ROP Programme (BanROPP)— private and government NICUS have been covered for ROP screening and treatment. It is the state’s only mobile ROP screening programme which uses a mobile camera for screening babies in the NICU. It has also collaborated with the Government through the RBSK for free ROP screening and treatment for premature babies across government NICUs and SNCUs.
Data from these efforts show that the prevalence of ROP in Meghalaya mirrors national figures. This clearly highlights the need for:
- sustained awareness,
- consistent screening, and
- strong collaborationsacross the state.
Why Collaboration Is Critical
Paediatricians and neonatologists are the first healthcare professionals to care for premature babies. They stabilize them, monitor their breathing, support their nutrition, and walk with families through the NICU journey. Their guidance carries enormous influence, especially when parents feel overwhelmed and emotionally exhausted.
Their role in preventing ROP-related blindness is therefore crucial.
If paediatricians insist on mandatory ROP screening… parents listen.
If neonatologists ensure screening before discharge… babies are protected.
If both communicate clearly about follow-ups… treatment is never delayed.
Ophthalmologists and retina specialists, on the other hand, rely on timely referrals. The success of ROP prevention depends heavily on seamless collaboration between neonatal teams, ophthalmologists, and parents.
Why Timely Screening Matters
ROP is a race against time. The disease progresses quickly, and the window for treatment is very narrow. Missing even one appointment can turn a treatable condition into irreversible blindness.
Current Screening Guidelines in India
Screening is mandatory for:
- Babies born at ≤ 34 weeks gestation
- Babies with birth weight ≤ 2000 g (2 kg)
- Babies born above 34 weeks but with complications such as sepsis, oxygen therapy, respiratory instability, or poor overall health
Screening must be done before NICU discharge or by 30 days of age, whichever comes first.
Parents must be encouraged to ask their healthcare team a simple but vital question:
“Has my baby been screened for ROP?”
If not, they should insist on it.
Who Should Perform the Screening?
ROP screening is not a routine eye check. It requires:
- A trained ophthalmologist or retina specialist
- Experience with premature infant eyes
- Specialized equipment to view the retina
Ideally, retinal imaging with a mobile imaging device should accompany screening. Imaging provides:
- documentation for follow-up
- improved accuracy
- remote expert review
- reduced chances of misdiagnosis
Most importantly, it ensures that no baby is missed.
Treatment: A Window of Hope
The encouraging truth is that ROP is treatable, especially when detected early. Treatment options include:
- Laser therapy to stop abnormal vessel growth
- Intravitreal injections in selected cases
- Surgery for advanced stages
When treatment is provided within the recommended window, the success rates are extremely high. This makes blindness due to ROP almost entirely preventable.
Parents’ Awareness: The Most Critical Factor
Parents of preterm babies face an emotional whirlwind—NICU stress, exhaustion, fear, and uncertainty. Amid all this, ROP screening can be easily forgotten, especially because the baby seems perfectly normal from the outside.
But it is vital for parents to understand:
➤ ROP gives no early warning signs.
By the time visible signs appear, it is often too late.
This delayed visibility is one of the main reasons babies go blind.
Visible signs such as:
- Not making eye contact
- Not following objects
- Excessive shaking of the eyes
- A white reflection in the pupil
appear much later, when the disease has already caused serious, often irreversible damage.
This is why parental awareness is just as important as medical expertise.
Parents must know that:
- A “healthy-looking” baby can still have severe ROP.
- Missing or delaying even one appointment can lead to blindness.
- ROP does not wait; it progresses silently.
- Only an eye specialist can detect it in time.
A well-informed parent is the strongest shield against preventable blindness.
The Road Ahead for Meghalaya
As the state continues to strengthen neonatal care, the next steps must include:
- Ensuring every NICU follows national ROP guidelines
- Increasing the number of trained ophthalmologists
- Strengthening follow-up systems
- Building stronger partnerships between public and private sectors
- Educating parents from the moment the baby enters the NICU
Meghalaya has the tools. It has the expertise. It has committed teams. What it now needs is continued collaboration and awareness.
Conclusion: A Vision-Safe Future for Every Preterm Baby
Premature babies are fighters—from their very first breath. They deserve not just to live, but to see the world they fought so hard to enter.
With awareness, responsibility, and timely action, no baby born too soon should ever go blind.
On this World Prematurity Day, let us commit—parents, doctors, nurses, hospitals, and programmes alike—to giving every premature baby a strong start, and an even stronger, brighter, sight-filled future.
(The writer is a Consultant Ophthalmologist and Retina and ROP Specialist at Bansara Eye Care Hospital, Shillong)
