From Preemie to First Eye Exam: What NICU Parents Should Know

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The other day, I walked into one of my outpatient exam rooms for retinopathy of prematurity (ROP) follow-up clinic. The baby had just been discharged from the NICU, and I was one of several ophthalmologists who had rotated through during their NICU stay. When I entered, the parents looked understandably confused—slightly agitated even.

They asked, “Why are we here? Didn’t someone already do the eye exam in the NICU?”

It’s a question I get often. And I get it—truly. As a mom of three myself, I understand how overwhelming the post-NICU period can be. When your baby is finally home, thriving, and beginning to hit milestones, the last thing you expect is a call reminding you to schedule yet another specialist appointment. It can feel like you’re being pulled back into that emotionally difficult season.

But here’s why that follow-up with your pediatric ophthalmologist really matters—and what you can expect from that six-month exam.

The NICU Might Be Over—But Your Baby’s Eyes Are Still Developing

If your baby was born prematurely, it’s likely they had ROP screenings in the NICU. But unless the ophthalmologist specifically documented that your baby’s retinas were fully mature before discharge, we’re not quite done.

That’s because the blood vessels in a premature baby’s eyes don’t always grow all the way to the edges of the retina before birth—and until they do, we have to keep monitoring them. Even if everything looked fine during the NICU stay, I still need to check that the retina continues maturing as it should. That often means seeing your baby again within a week of discharge.

Now, let’s say your baby did have fully mature vascularization before going home (a moment I love to document with a little smiley face in the chart—because it really is a milestone!). Even then, you’ll still need a follow-up eye exam around six months of age. Why? Because premature babies are at a higher risk for developing certain vision problems like strabismus (eye misalignment), high refractive error (strong glasses prescriptions), or amblyopia (“lazy eye”).

So, What Exactly Am I Looking for at This Visit?

Unlike the intense NICU eye exams (with lid speculums, bright lights, and eye movement tools), the six-month outpatient exam is gentler—but no less important.

Here’s what I’m checking:

✧ Pupil reaction – Are they equal and responsive to light?
✧ Visual behavior – Is your baby tracking faces or objects? Are they beginning to fixate?
✧ Alignment – Are the eyes straight, or is there crossing or drifting?
✧ Refractive error – Using a retinoscope, I’ll measure whether your baby is farsighted, nearsighted, or has astigmatism.
✧ Dilated fundus exam – I’ll take a quick look inside the eye to make sure everything is structurally healthy.

Most importantly, I’m looking for signs of delayed visual maturation, which is the most common issue I see in preemies. It’s not a disease—just a developmental delay. Vision development is like a dimmer switch, not an on/off light. For some babies, especially those born early, it simply takes a bit more time.

What If My Baby Still Isn’t Making Eye Contact?

This is one of the most common concerns I hear.

You bring your baby home. They’re eating. Growing. Meeting some milestones. But… they’re not looking at you. Not tracking. And understandably, that can be scary.

Here’s the reassuring truth: Premature babies often lag behind on visual development just like they do with physical milestones. We base everything on adjusted age, not actual birth date. So if your baby was born two months early, we look for tracking and visual engagement at around 3–6 months adjusted age—not calendar age.

There’s no special formula, no eye exercises, no magic toy that will suddenly jumpstart vision. Just give it time, and keep showing up for these follow-up appointments so we can monitor progress and rule out any rare but serious issues.

Questions to Ask Your Pediatric Ophthalmologist

You are your baby’s best advocate. If you’re walking into one of these visits and you’re not sure what to ask, here are a few questions I recommend bringing up:

✧ Is my baby’s vision on track for their age?
✧ Are their eyes aligned, or is there any drifting/crossing?
✧ Do they need glasses now—or might they in the future?
✧ Are there signs of amblyopia (lazy eye)?
✧ What should I be watching for at home?
✧ When should we follow up again?

And please—bring pictures or videos if something looks off at home. No doctor is going to fault you for being vigilant. We’re a team, and your observations matter.

Final Thoughts for NICU Parents

If you’re reading this, you’ve already made it through so much.

You’ve navigated monitors and feeding tubes, rounds and rollercoasters. An eye appointment might feel small in comparison—but I promise you, it’s part of the bigger picture of helping your baby thrive.

Premature babies are some of the most resilient people I know. Their bodies—and their brains—do amazing things with just a little time and care.

So don’t skip that eye exam. It’s not just a box to check. It’s a step toward ensuring your baby sees this beautiful world as clearly and fully as possible.

Want to Learn More?

This is just the beginning. In upcoming episodes, we’ll explore:
-How screen time and digital habits are shaping our kids’ development
–The connection between vision and overall health
–What you need to know about common eye procedures like LASIK and cataract surgery
–Practical ways to advocate for your child’s visual needs

You can subscribe to my podcast, In Focus, anywhere you listen—or follow along on Instagram for updates and tips.

Watch this episode on Youtube right now!

Thanks for reading—and for doing what you can to protect your child’s vision, one step at a time.

– Dr. Rupa Wong
Pediatric Ophthalmologist | Surgeon | Mom of 3

This episode is brought to you by The Pinnacle Podcast Network! Learn more about Pinnacle at learnatpinnacle.com