1. Extreme prematurity was associated with an increased prevalence of visual and ocular deficits, suggesting children born extremely preterm may have residual ophthalmic sequelae persisting into adulthood.
2. These findings emphasized the need for screening and management of any deficits as they evolve long-term at a population-level.
Evidence Rating Level: 2 (Good)
Study Rundown: Although it is known that preterm infants are at greater risk of visual impairment and ocular morbidities compared to term infants during early life, few studies have described the long-term ocular sequelae in adulthood for individuals born extremely preterm (EP) with or without retinopathy of prematurity (ROP). This study assessed and compared visual function and ocular morbidity in young adults born at 22-25 weeks’ gestation to those of full-term controls, with the hypothesis of an increased rate of visual and ocular abnormalities in EP births persisting into early adulthood, most frequent for those who had neonatal ROP. The main outcomes included best-corrected visual acuity, refractive status, contrast sensitivity, color vision, prevalence of strabismus and nystagmus, and patient-reported visual function. Comparing 128 young adults born EP with 65 age-matched full-term controls, extreme prematurity was associated with an increased prevalence of visual and ocular deficits, suggesting children born EP may have residual ophthalmic sequelae persisting into adulthood. However, further comparisons showed that patient-perceived visual health status of individuals born EP remained good overall. These findings emphasized that all EP infants are at risk of visual and ocular morbidity irrespective of ROP status and the need for screening and management of any deficits as they evolve long-term. A limitation of this study was participant attrition due to the longitudinal design of the study resulting in data from less than half of the participants in both groups after 20 years.
Click to read the study in JAMA Network Open
Relevant Reading: Retinopathy of prematurity: a review of risk factors and their clinical significance
In-Depth [prospective cohort]: This study comprised of 128 young adults born EP (256 eyes; 68 [53%] females; mean [SD] age, 19.3 [0.5] years) and 65 age-matched controls born at full term (130 eyes; 40 [62%] females; mean [SD] age, 19.2 [0.5] years) from the UK and Ireland born between March to December 1995. All participants underwent eye examinations as part of a comprehensive outcome evaluation. Compared to the control group, the mean (SD) best-corrected visual acuity in the EP group was significantly worse for both monocular vision (−0.06 [0.14] logMAR in controls vs 0.14 [0.38] logMAR in EP; P < .001) and binocular vision (−0.14 [0.15] logMAR in controls vs 0.06 [0.37] logMAR in EP; P < .001). Compared to the controls, young adults born EP had a significantly higher prevalence of strabismus (36% [46 of 127] vs 0%; P < .001), abnormal ocular motility (15% [19 of 125] vs 0%; P < .001), and nystagmus (13% [16 of 127] vs 0%; P < .001). However, there were no significant differences for refractive error, contrast sensitivity, color vision, or patient reported visual function between the two groups. Within the EP group, 48% of eyes (120 of 250) had no ROP, 39% (98 of 250) had ROP not requiring neonatal treatment, and 13% (32 of 250) received cryotherapy or laser ablation for ROP, where there were no significant differences in binocular visual function parameters, prevalence of ocular morbidity, and patient-reported visual function by neonatal ROP status.
Image: PD
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