A Simple Eye Drop That Might Help Protect Premature Babies' Eyesight

What a new Swedish study found when it tested steroid eye drops against a serious eye condition of prematurity — and why the results are promising but not yet proof

A new Swedish trial tested whether a simple steroid eye drop could help protect the eyes of very premature babies from a sight-threatening condition called retinopathy of prematurity. Fewer babies who got the drops went on to need eye surgery or injections than babies who got a placebo — but the difference, while promising, was not quite large enough for scientists to call it proven.

Why This Question Matters — and How Families Used to Face It

Retinopathy of prematurity, usually shortened to ROP, is a condition where the blood vessels in a premature baby's retina — the light-sensing layer at the back of the eye — grow abnormally after birth. It happens because those blood vessels are still developing when a baby is born very early, and the switch from growing inside the womb to growing outside it can throw that delicate process off course. In its mildest forms, ROP causes no lasting harm and resolves on its own. In its more severe forms, it can lead to a detached retina and permanent blindness if it is not caught and treated in time. For decades, families of extremely premature babies have faced this the same way: their baby is screened with repeated eye exams in the weeks after birth, and if the disease crosses a certain danger line, doctors treat it — first with a freezing technique called cryotherapy, developed and proven effective in the 1980s, and later with laser treatment, which does the same job with less damage to the surrounding eye [1]. More recently, some babies have instead received an injection of a drug that blocks the growth signal driving the abnormal vessels, an option shown to work especially well for the most severe, centrally located disease [2]. All of these treatments share one thing in common: they only step in after the disease has already become severe enough to threaten a baby's sight. Nothing, until now, had been tested as a way to calm the disease down earlier, before it gets to that point — which is exactly the gap the new trial, called DROPROP, was designed to explore [3].

What the Researchers Did

Doctors at fourteen hospitals across Sweden — six university hospitals and eight smaller regional ones — enrolled 100 babies who were born before 30 weeks of pregnancy (a full-term pregnancy is 40 weeks) and who had already developed a moderate, "in-between" stage of ROP: serious enough to need close watching, but not yet at the point where treatment is required [3],[4]. Half of the babies, chosen at random, received dexamethasone eye drops — a mild steroid medicine, delivered as drops directly onto the eye rather than as a pill or injection into the bloodstream — once a day or every other day for up to twelve weeks. The other half received plain saline drops that looked identical, so that neither the baby's care team nor the researchers assessing the eyes knew who had received which, a method called masking that keeps a trial's results honest. The study ran from late 2022 through late 2025 and was designed, before it started, around the hope that the drops might cut the rate of babies needing eye treatment roughly in half [4].

What They Found

Among babies who received the steroid drops, 10 out of 50 (1 in 5) went on to need eye treatment, compared with 19 out of 50 (nearly 2 in 5) among babies who received the placebo drops [3]. That is a meaningful-looking gap — roughly one fewer baby needing treatment for every five or six babies given the drops — and it lines up with the size of benefit the researchers had hoped to find. However, when researchers ran the statistics, the result landed just short of the threshold scientists use to call a finding "statistically significant," meaning there is still some chance the difference happened by chance rather than because of the drops. The babies who received the eye drops were somewhat more likely to have mildly raised pressure inside the eye (about 1 in 4, compared with about 1 in 5 in the placebo group) and four babies who received the drops lost more weight than expected during treatment — something the researchers flagged for future studies to watch closely, though no baby in either group suffered a serious complication from the treatment itself [3].

What This Means for Families

If your baby has been diagnosed with retinopathy of prematurity, this study is genuinely encouraging news, but it is not yet a reason to expect steroid eye drops to be offered as standard care. The results suggest a real possibility that a simple, inexpensive, non-invasive eye drop could one day reduce how often premature babies need eye surgery or injections — and unlike a steroid pill or injection that travels through a baby's whole bloodstream, an eye drop is designed to act mostly where it is placed, which is reassuring for parents who understandably worry about medicines that affect a fragile, still-developing body more broadly [5]. But because this study, while carefully done, only followed 100 babies, doctors need a larger study — following several hundred babies — before this can become a routine treatment. Your baby's care team will continue to follow the same screening and treatment approach used today, checking your baby's eyes on a regular schedule and stepping in with laser or injection treatment if and when it is needed, exactly as they would have before this study was published [6]. If you have questions about your own baby's eye screening or about this study, your neonatology and ophthalmology teams are the best people to ask, since they can put these findings in the context of your baby's own gestational age, eye findings, and overall health. It is also worth knowing that the babies who took part in this trial were watched closely for side effects the whole time they were on the drops, and the research team is continuing to follow them to check on their growth and vision as they get older — the kind of careful, patient follow-through that gives real weight to whatever a larger future trial eventually finds.

The Bigger Picture

Retinopathy of prematurity is not a rare, isolated concern — it remains one of the leading causes of preventable blindness in children worldwide, and the risk is highest in places where more premature babies are surviving than there are eye specialists and equipment to screen them in time [7]. That is part of why a cheap, easy-to-give eye drop is such an appealing idea if it is eventually proven to work: unlike laser treatment or eye injections, which require specialized equipment and training, eye drops could in principle be given almost anywhere a baby is being cared for. The Swedish research team behind this trial has spent over twenty years studying why premature babies' eyes are vulnerable in the first place, tracing much of the risk to low levels of a growth hormone called IGF-1 that babies would normally still be receiving from their mothers in the womb — work that helped explain, at a biological level, why calming the eye's blood-vessel growth signal earlier might help, and that laid the scientific groundwork for testing an eye drop in the first place [8],[9]. Two other lines of research help explain why doctors have kept searching for better ways to prevent this disease rather than settling for treating it once it appears. In the early 2000s, a large US-led study found that treating a slightly earlier, less severe stage of the disease led to better long-term vision than waiting for it to become more advanced, which is why today's screening programs catch and act on the disease earlier than they once did [10]. Around the same time, another group of researchers tested whether simply giving premature babies more oxygen once early warning signs appeared could stop the disease from getting worse; it could not, which taught doctors that once the disease has started down its abnormal path, adjusting oxygen levels alone is not enough to reverse it, and something that acts more directly on the eye is needed [11].

What Comes Next

The research team has said they plan to follow these babies for longer, to see whether the modest reduction in treatment seen so far translates into better vision as the children grow. Scientists elsewhere are likely to design a larger, follow-up trial to confirm or refute what this study found, and it is worth remembering that many treatments that eventually became standard care in medicine first showed exactly this kind of "promising but not proven" result before a bigger study settled the question. For now, the honest and hopeful summary is this: a simple eye drop showed a real signal of benefit for a serious condition of prematurity, it appears safe over the twelve weeks it was studied, and the next step is simply for science to confirm, with more babies, whether that early signal holds up.

References

  1. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter Trial of Cryotherapy for Retinopathy of Prematurity: Preliminary Results. Pediatrics. 1988;81(5):697-706. doi:10.1542/peds.81.5.697 ↩
  2. Mintz-Hittner HA, Kennedy KA, Chuang AZ; BEAT-ROP Cooperative Group. Efficacy of Intravitreal Bevacizumab for Stage 3+ Retinopathy of Prematurity. N Engl J Med. 2011;364(7):603-615. doi:10.1056/NEJMoa1007374 ↩
  3. Hellström A, Petrishka-Lozenska M, Pivodic A, et al; DROPROP collaboration group. Dexamethasone Eye Drops to Prevent Treatment-Requiring Retinopathy of Prematurity: The DROPROP Randomized Clinical Trial. JAMA Pediatr. 2026 (published online Aug 3). doi:10.1001/jamapediatrics.2026.3247 ↩
  4. Hellström A, Petrishka-Lozenska M, Pivodic A, et al; DROPROP collaboration group. Evaluation of timed dexamethasone eye drops to prevent proliferative retinopathy of prematurity: a study protocol for a randomized intervention, multi-centre, double-blinded trial (DROPROP). BMC Pediatr. 2025;25(1):332. doi:10.1186/s12887-025-05673-x ↩
  5. Doyle LW, Cheong JLY, Hay S, Manley BJ, Halliday HL, Soll R. Early (<7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database Syst Rev. 2021;2022(5):CD001146. doi:10.1002/14651858.CD001146.pub6 ↩
  6. Fierson WM, Chiang MF, Good W, et al; American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018;142(6):e20183061. doi:10.1542/peds.2018-3061 ↩
  7. Blencowe H, Lawn JE, Vazquez T, Fielder A, Gilbert C. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res. 2013;74(Suppl 1):35-49. doi:10.1038/pr.2013.205 ↩
  8. Hellström A, Perruzzi C, Ju M, et al. Low IGF-I suppresses VEGF-survival signaling in retinal endothelial cells: direct correlation with clinical retinopathy of prematurity. Proc Natl Acad Sci U S A. 2001;98(10):5804-5808. doi:10.1073/pnas.101113998 ↩
  9. Hartnett ME, Penn JS. Mechanisms and Management of Retinopathy of Prematurity. N Engl J Med. 2012;367(26):2515-2526. doi:10.1056/NEJMra1208129 ↩
  10. Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised Indications for the Treatment of Retinopathy of Prematurity: Results of the Early Treatment for Retinopathy of Prematurity Randomized Trial. Arch Ophthalmol. 2003;121(12):1684-1696. doi:10.1001/archopht.121.12.1684 ↩
  11. STOP-ROP Multicenter Study Group. Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP), A Randomized, Controlled Trial. I: Primary Outcomes. Pediatrics. 2000;105(2):295-310. doi:10.1542/peds.105.2.295 ↩