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Functional result and visual outcome in early versus conventional treatment of retinopathy of prematurity
Sukhuma Warrasak1, Sarinda Nawarutkulchai, Pannaluck Sinsawat
1Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. sukhuma@csloxinfo.com
Insights
Early treatment for retinopathy of prematurity (ROP) leads to better vision and fewer complications than conventional treatment. Prompt ROP detection and management are crucial for preserving childhood sight.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Retinal Diseases
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness globally.
- Timely intervention is critical for managing ROP and preventing vision loss.
Purpose of the Study:
- To compare the long-term structural and functional outcomes of early versus conventional treatment for ROP.
- To evaluate the impact of treatment timing on visual acuity, refractive status, and ocular alignment.
Main Methods:
- A cohort of ROP survivors treated between 1997-2001 were reassessed in 2006.
- Functional outcomes (visual acuity, refractive state) and anatomical outcomes (retina status, ocular alignment) were compared between early and conventional treatment groups.
- Statistical analysis was performed using the Chi-square test.
Main Results:
- Early treatment resulted in significantly better visual acuity (54.5% with normal/near-normal vision vs. 23.2%) compared to conventional treatment.
- Higher rates of high myopia and astigmatism were observed in the conventionally treated group.
- Early treatment was associated with a lower prevalence of significant esotropia (ET).
Conclusions:
- Early ROP treatment at the pre-threshold stage yields superior structural and functional outcomes.
- Regular fundus examinations and vision assessments are recommended for early ROP detection and management.
- Prompt correction of refractive errors and strabismus is vital for ROP patients.
Objective:
Retinopathy of prematurity (ROP) is a significant cause of blindness in childhood worldwide. The objective of the present study is to assess long-term structural and functional results of early (received first treatment at pre-threshold stage) versus conventional treatment (treated at threshold stage) of ROP MATERIAL AND METHOD: Survivors of ROP patients who underwent early or conventional treatment between 1997 and 2001 were reassessed in 2006. Functional outcome [refractive state, best corrected visual acuity (BCVA)] and anatomical outcome (retina status, ocular alignment) were compared between the two treatments using Chi-square test at p < 0.05.
Results:
Of 68 patients, 39 (57.4%) returned for reassessment: 11 patients (22 eyes) were in the early treatment group and 28 patients (56 eyes) were in the conventional group. At 5 years or more, a favorable outcome (BCVA > 20/200) was achieved in 72.7% of the early group vs. 53.6% in the conventional group (p > 0.05). Normal to near normal vision (20/12-20/60 or log MAR 0.1-0.5) was significantly found in the early group (54.5% vs. 23.2%, p = 0.008) and none in the early group lost vision to no light perception. Prevalence of high myopia > 5 diopters and astigmatism were significantly higher in the conventional group (p = 0.001 and p = 0.002 respectively). Smaller degree of ET developed significantly in the early treated group (p = 0.018) whereas ET 15 prisms or more developed exclusively in the conventional group (p = 0.04). Retinal detachment occurred in 18.1% of the early treated compared to 28.5% of the conventional groups (p = 0.402).
Conclusion:
Early treatment of ROP at pre-threshold stage offered a better structural and functional outcome than at threshold. ROP patients should undergo periodic fundus examination between 6 months and 1 year of age and yearly thereafter for early detection and repair as well as yearly refraction and ocular alignment assessment to identify high refractive errors, astigmatism and strabismus for early recognition and correction.
