ROP located in which zone has a much worse prognosis?

• A. Zone 2
• B. Zone 3
• C. Zone 4
• D. Zone 1

Answer: (D)

In retinopathy of prematurity, how far back the abnormal vessels are growing in the retina strongly influences outcomes. The most posterior part of the retina, closest to the optic nerve and fovea, carries the highest risk because involvement there means the central retina—and potentially the macula—are affected. Disease in this central zone tends to progress more rapidly to proliferative changes and can lead to poor visual outcomes even with treatment. That’s why this posterior location is associated with a much worse prognosis. In contrast, disease that is more peripheral tends to have a slower course and responds better to interventions, leading to a comparatively better prognosis.