Background: Retinopathy of prematurity (ROP) has become one of the most significant preventable causes of childhood visual morbidity in the era of improved neonatal survival. The scientific literature has established that ROP is not limited to an acute retinal vascular event in infancy, but is also associated with later refractive errors, altered ocular biometry, macular changes, and variable long-term visual function. At the same time, medical education literature increasingly emphasizes that emotionally intelligent, competency-based clinical practice is essential in complex, high-stakes care environments. Despite this, the long-term ophthalmic literature on ROP and the professional competency literature on emotional intelligence in medicine are rarely examined together.

Objective: This article develops an integrative theoretical analysis of the relationship between long-term visual and biometric outcomes in ROP and the emotional-intellectual competencies required for high-quality neonatal ophthalmic care. It argues that optimal ROP management depends not only on timely screening and treatment but also on emotionally intelligent communication, competent judgment, follow-up discipline, and interprofessional coordination.

Methods: A text-based integrative review methodology was applied using only the supplied references. The literature was grouped into four analytical domains: childhood blindness and ROP burden; retinal vascular development, screening, treatment, and long-term ocular outcomes; competency-based medical education and entrustment; and emotional intelligence in medicine, nursing, leadership, and decision-making. The review then synthesized these domains into a unified interpretive framework.

Results: The literature indicates that ROP contributes substantially to long-term visual burden through persistent refractive, structural, and functional effects, even after treatment success in infancy (Fielder et al., 2015; Good et al., 2010; Kaur et al., 2021; Lee et al., 2018). Treatment modality influences later outcomes, particularly refractive and biometric development (Geloneck et al., 2014; Chen & Chen, 2020; Yang et al., 2013). The emotional intelligence literature suggests that self-awareness, empathy, emotional regulation, teamwork, and judgment are highly relevant to medical practice, especially in emotionally charged and high-stakes settings (Arora et al., 2010; Mayer et al., 2016; Lerner et al., 2015; Johnson, 2015). These capacities align strongly with the demands of ROP screening, treatment decision-making, parent counseling, and long-term follow-up.

Conclusion: ROP should be understood not only as a retinal disease but as a longitudinal developmental and professional-care challenge. Future ROP programs and neonatal ophthalmic training models should integrate long-term outcome science with competency-based education and emotional intelligence development to improve patient-centered visual care.

Retinopathy of prematurity, emotional intelligence, neonatal ophthalmology

Allen SJ, Shankman ML, Miguel RF. Emotionally intelligent leadership: An integrative, process-oriented theory of student leadership. Journal of Leadership Education. 2012;11(1):177–203. Available from: https://dx.doi.org/10.12806/v11/i1/tf1

Arora S, Ashrafian H, Davis R, Athanasiou T, Darzi A, Sevdalis N. Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies. Medical Education. 2010;44(8):749–764. Available from: https://dx.doi.org/10.1111/j.1365-2923.2010.03709.x

Chew BH, Zain AM, Hassan F. Emotional intelligence and academic performance in first and final year medical students: A cross sectional study. BMC Medical Education. 2013;13(1):1–10. Available from: https://doi.org/10.1186/1472-6920-13-44

Chen YC, Chen SN. Foveal microvasculature, refractive errors, optical biometry and their correlations in school-aged children with retinopathy of prematurity after intravitreal antivascular endothelial growth factors or laser photocoagulation. British Journal of Ophthalmology. 2020;104(5):691–696. Available from: https://doi.org/10.1136/bjophthalmol-2019-314610

Chitra A. Impact of socio economic status of parents’ on the emotional intelligence of generation alpha kids. International Journal of Latest Technology in Engineering, Management & Applied Science. 2020;9(6):46–48. Available from: https://www.ijltemas.in/DigitalLibrary/Vol.9Issue6/46-48.pdf

Donzis PB, Insler MS, Gordon RA. Corneal curvatures in premature infants. American Journal of Ophthalmology. 1984;98(5):627–628. Available from: https://dx.doi.org/10.1016/0002-9394(84)90253-8

EG, Barfroshan S, Ghoreishi G, Balouchi A, NN, AA. The association of self-assessed emotional intelligence with academic achievement and general health among students of medical sciences. Global Journal of Health Science. 2016;8(12):27–35. Available from: https://doi.org/10.5539/gjhs.v8n12p27

Ehrlich DL, Atkinson J, Braddick O, Bobier W, Durden K. Reduction of infant myopia: a longitudinal cycloplegic study. Vision Research. 1995;35(9):1313–1324. Available from: https://doi.org/10.1016/0042-6989(94)00228-E

Ewaiwe B, Attiyeh R, Niroukh E, et al. Emotional intelligence among medical students and residents in Palestine: A cross-sectional study. 2020. Available from: https://doi.org/10.22541/au.158809487.70957539

Farvardin M, Kalantari Z, Talebnejad M, Norouzpour A. Long-term visual and refractive outcomes of argon laser-treated retinopathy of prematurity. Journal of Ophthalmic and Vision Research. 2022;17(3):384–389. Available from: https://doi.org/10.18502/jovr.v17i3.11576

Fielder A, Blencowe H, O'Connor A, Gilbert C. Impact of retinopathy of prematurity on ocular structures and visual functions. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2015;100(2):F179–F184. Available from: https://doi.org/10.1136/archdischild-2014-306207

García-Sancho E, Salguero JM, Fernández-Berrocal P. Relationship between emotional intelligence and aggression: A systematic review. Aggression and Violent Behavior. 2014;19(5):584–591. Available from: https://doi.org/10.1016/j.avb.2014.07.007

Geloneck MM, Chuang AZ, Clark WL, Hunt MG, Norman AA, Packwood EA, et al. Refractive outcomes following bevacizumab monotherapy compared with conventional laser treatment: a randomized clinical trial. JAMA Ophthalmology. 2014;132(11):1327–1333. Available from: https://doi.org/10.1001/jamaophthalmol.2014.2772

George PS, Anuradha M, Rose BM, John A. Emotional intelligence among medical students: a cross sectional study from central Kerala, India. International Journal of Community Medicine and Public Health. 2022;9(3):1338–1346. Available from: https://doi.org/10.18203/2394-6040.ijcmph20220692

Goggin M, O'Keefe M. Childhood blindness in the Republic of Ireland: a national survey. British Journal of Ophthalmology. 1991;75(7):425–429. Available from: https://doi.org/10.1136/bjo.75.7.425

Good WV, Hardy RJ, Dobson V, Palmer EA, Phelps DL, Tung B, et al. Final visual acuity results in the early treatment for retinopathy of prematurity study. Archives of Ophthalmology. 2010;128(6):663–671. Available from: https://doi.org/10.1001/archophthalmol.2010.72

Gordon RA, Donzis PB. Refractive development of the human eye. Archives of Ophthalmology. 1985;103(6):785–789. Available from: https://doi.org/10.1001/archopht.1985.01050060045020

Harrell SN, Brandon DH. Retinopathy of prematurity: the disease process, classifications, screening, treatment, and outcomes. Neonatal Network. 2007;26(6):371–378. Available from: https://doi.org/10.1891/0730-0832.26.6.371

How emotionally intelligent are you? 2021. Available from: https://www.verywellmind.com/what-is-emotional-intelligence-2795423

IBM SPSS Statistics for Windows (Version 27.0) [Computer software]. IBM Corp. Available from: https://www.ibm.com/products/spss-statistics

Johnson DR. Emotional intelligence as a crucial component to medical education. International Journal of Medical Education. 2015;6:179–183. Available from: https://doi.org/10.5116/ijme.5654.3044

Kaur S, Dogra M, Sukhija J, Samanta R, Singh SR, Grover S, et al. Preterm refraction and ocular biometry in children with and without retinopathy of prematurity in the first year of life. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2021;25(5):271.e1–271.e6. Available from: https://doi.org/10.1016/j.jaapos.2021.05.012

Kumar A, Puranik MP, Sowmya KR. Association between dental students' emotional intelligence and academic performance: A study at six dental colleges in India. Journal of Dental Education. 2016;80(5):526–532. Available from: https://pubmed.ncbi.nlm.nih.gov/27139203/

Lee YS, See LC, Chang SH, Wang NK, Hwang YS, Lai CC, et al. Macular structures, optical components, and visual acuity in preschool children after intravitreal bevacizumab or laser treatment. American Journal of Ophthalmology. 2018;192:20–30. Available from: https://doi.org/10.1016/j.ajo.2018.05.002

Lerner JS, Li Y, Valdesolo P, Kassam KS. Emotion and decision making. Annual Review of Psychology. 2015;66:799–823. Available from: https://doi.org/10.1146/annurev-psych-010213-115043

Mayer JD, Caruso DR, Salovey P. The ability model of emotional intelligence: Principles and updates. Emotion Review. 2016;8(4):290–300. Available from: https://dx.doi.org/10.1177/1754073916639667

McLeod DS, Hasegawa T, Prow T, Merges C, Lutty G. The initial fetal human retinal vasculature develops by vasculogenesis. Developmental Dynamics. 2006;235(12):3336–3347. Available from: https://doi.org/10.1002/dvdy.20988

McLoone EM, O'Keefe M, McLoone SF, Lanigan BM. Long-term refractive and biometric outcomes following diode laser therapy for retinopathy of prematurity. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2006;10(5):454–459. Available from: https://doi.org/10.1016/j.jaapos.2006.05.005

McQueen ACH. Emotional intelligence in nursing work. Journal of Advanced Nursing. 2004;47(1):101–108. Available from: https://doi.org/10.1111/j.1365-2648.2004.03069.x

Modi JN, Gupta P, Singh T. Competency-based medical education, entrustment and assessment. Indian Pediatrics. 2015;52(5):413–420. Available from: https://doi.org/10.1007/s13312-015-0647-5

Mohammed QQ, Mohammed AY. Emotional intelligence among undergraduate medical students at University of Baghdad. A Emotional Intelligence Among Undergraduate Medical Students at University of Baghdad. 2020;1(2):1–5. Available from: http://dx.doi.org/10.31031/ajhs.2020.01.000509

O'Connor AR, Stephenson TJ, Johnson A, Tobin MJ, Ratib S, Fielder AR. Change of refractive state and eye size in children of birth weight less than 1701 g. British Journal of Ophthalmology. 2006;90(4):456–460. Available from: https://doi.org/10.1136/bjo.2005.083535

Puliyakkadi S, Chalil S, Abraham R, Dipin J, Raj A, Dayan S. Dimensions of emotional intelligence of doctors in a tertiary care centre in Kerala. Journal of Integrated Health Sciences. 2019;7(2):48–51. Available from: https://doi.org/10.4103/JIHS.JIHS_32_19

Romanelli F, Cain J, Smith KM. Emotional intelligence as a predictor of academic and/or professional success. American Journal of Pharmaceutical Education. 2006;70(3):1–10. Available from: https://dx.doi.org/10.5688/aj700369

Shukla R, Murthy GV, Gilbert C, Vidyadhar B, Mukpalkar S. Operational guidelines for ROP in India: a summary. Indian Journal of Ophthalmology. 2020;68(Suppl 1):S108–S114. Available from: https://doi.org/10.4103/ijo.IJO_1827_19

Sundararajan S, Gopichandran V. Emotional intelligence among medical students: a mixed methods study from Chennai, India. BMC Medical Education. 2018;18(1):1–9. Available from: https://doi.org/10.1186/s12909-018-1213-3

The quick emotional intelligence self-assessment. 2024. Available from: https://neotecouncil.org/wp-content/uploads/2012/04/EmotionalIntelligence-Self-Assessment.pdf

Theng JT, Wong TY, Ling Y. Refractive errors and strabismus in premature Asian infants with and without retinopathy of prematurity. Singapore Medical Journal. 2000;41(8):393–397. Available from: https://pubmed.ncbi.nlm.nih.gov/11256347/

Todres M, Tsimtsiou Z, Stephenson A, Jones R. The emotional intelligence of medical students: an exploratory cross-sectional study. Medical Teacher. 2010;32(1):42–48. Available from: https://doi.org/10.3109/01421590903199668

Vadivel K. Gender difference in emotional intelligence and its component traits in medical students. International Journal of Physiology. 2019;7(4):85–88. Available from: https://doi.org/10.37506/ijop.v7i4.64

Vasefi A, Dehghani M, Mirzaaghapoor M. Emotional intelligence of medical students of Shiraz University of Medical Sciences cross sectional study. Annals of Medicine and Surgery. 2018;32:26–31. Available from: https://doi.org/10.1016/j.amsu.2018.07.005

Vujanović MS, Stanković-Babić GL, Oros A, Zlatanović GD, Jovanović P, Cekić SP, et al. Refractive errors in premature infants with retinopathy of prematurity after anti-vascular endothelial growth factor therapy. Vojnosanitetski Pregled. 2017;74(4):323–328. Available from: https://doi.org/10.2298/VSP150831191V

Yang CS, Wang AG, Shih YF, Hsu WM. Long-term biometric optic components of diode laser-treated threshold retinopathy of prematurity at 9 years of age. Acta Ophthalmologica. 2013;91(4):276–282. Available from: https://doi.org/10.1111/aos.12053

Zeng X, Chen M, Zheng L, Tian R, Chen Y, He H, et al. Study of the biological developmental characteristics of the eye in children after laser surgery for the treatment of retinopathy of prematurity. Frontiers in Medicine. 2022;8:1–8. Available from: https://dx.doi.org/10.3389/fmed.2021.783552