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Long term follow up of premature infants: detection of strabismus, amblyopia, and refractive errors
N E Schalij-Delfos1, M E de Graaf, W F Treffers
1FC Donders Institute of Ophthalmology, University Hospital, Utrecht, Netherlands. N.Schalijdelfos@oogh.azu.nl
Insights
Premature infants born before 32 weeks gestational age (GA) are at higher risk for developing strabismus, amblyopia, and refractive errors. Long-term ophthalmological follow-up is recommended for these high-risk infants.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Background:
- Premature infants face increased risks for visual impairments.
- Long-term ophthalmological follow-up is crucial for early detection and management.
Purpose of the Study:
- To establish recommendations for long-term ophthalmological follow-up in prematurely born infants.
- To identify predictive factors for visual development in preterm infants.
Main Methods:
- Prospective study of 130 infants with gestational age (GA) <37 weeks.
- Ophthalmological assessments at multiple time points from post-conception to 5 years.
- Stratification of infants into groups based on GA: <28, 28-32, and >32 weeks.
Main Results:
- Infants with GA ≤32 weeks had a significantly higher risk of developing strabismus, amblyopia, or refractive errors (SAR).
- Gestational age, oxygen duration, and hospitalization duration were predictive variables for SAR.
- Strabismus primarily developed within the first year and by age 5; amblyopia was often detected by 2-3 years; refractive errors appeared at various intervals.
Conclusions:
- Infants with GA <32 weeks require targeted long-term ophthalmological follow-up.
- Recommended screening schedule includes ages 1 year, 30 months, and pre-school.
- Visual acuity testing with optotypes is essential before school entry.
Aim:
To establish recommendations for long term ophthalmological follow up of prematurely born infants.
Methods:
130 infants with a gestational age (GA) <37 weeks and born between 1 November 1989 and 31 October 1990 were enrolled in a prospective study about the development of strabismus, amblyopia, and refractive errors. Infants were subdivided in three groups according to GA: A <28 weeks (n=32), B >/=28-32-<37 weeks (n=34). Ophthalmological assessment took place at the postconceptional age of 32 weeks, at term and at 3, 6, 12, and 30 months post term. At the age of 5 years parents received a questionnaire and a majority of the children was examined again (n=99).
Results:
At the age of 5 years 46 infants were known to have strabismus (n=29) and/or amblyopia (n=22) and/or refractive errors (n=22). Statistical analysis showed that gestational age, duration of supplementary oxygen, and duration of hospitalisation were important predictive variables for the development of strabismus, amblyopia, or refractive errors (SAR) at the age of 5 years (p<0.05). Infants with a GA 32 weeks, who developed an incidence comparable with the normal population. Strabismus developed mainly in the first year of life and at the age of 5 years. Most infants with amblyopia were detected at the age of 2-3 years. Refractive errors were found in the first year of life and at the age of 2.5 and 5 years.
Conclusion:
Infants with a GA <32 weeks should be selected for long term ophthalmological follow up. These infants should be screened at the age of 1 year, in the third year of life (preferably at 30 months), and just before school age (including testing of visual acuity with optotypes).