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Published on: September 3, 2020
Fundus-Controlled Dark Adaptometry in Young Children Without and With Spontaneously Regressed Retinopathy of
Wadim Bowl1, Birgit Lorenz1, Knut Stieger1
1Department of Ophthalmology, Justus-Liebig-University, Giessen, Germany.
Insights
Premature children with macular developmental arrest (MDA) show delayed dark adaptation, indicating long-term visual pathway deficits. These foveal changes impact both rod and cone photoreceptor function, affecting vision in former preterm infants.
Area of Science:
- Ophthalmology
- Developmental Biology
- Retinal Imaging
Background:
- Premature birth can lead to visual impairments.
- Macular developmental arrest (MDA) is a foveal morphologic alteration.
- Assessing visual function in preterm children is crucial for understanding long-term outcomes.
Purpose of the Study:
- To correlate dark adaptation with foveal morphologic alterations in preterm and term-born children.
- To investigate the impact of MDA on visual pathways using advanced imaging techniques.
Main Methods:
- Fundus-controlled chromatic dark adaptometry was performed in preterm children (with and without a history of retinopathy of prematurity) and term-born controls.
- Spectral domain-optical coherence tomography (SD-OCT) and the DiOCTA tool were used to analyze macular developmental arrest (MDA).
Main Results:
- Children with MDA exhibited a delayed rod-mediated sensitivity recovery (0.0113 vs. 0.0253 dB/s).
- While final rod-mediated thresholds were similar, cone-mediated dark adaptation showed a significantly lower final threshold in children with MDA (6.0 vs. 8.1 dB).
- Changes in dark adaptation were observed in preterm children with MDA, irrespective of retinopathy of prematurity history.
Conclusions:
- Macular developmental arrest (MDA) in former preterm children is linked to functional deficits in cone and rod photoreceptor pathways.
- Morphologic changes in the central retina of preterm children, as seen in SD-OCT, correlate with long-term visual pathway deficits.
- These findings suggest a broader retinal functional pathology associated with foveal alterations in preterm individuals.
Purpose:
We correlate dark adaptation course with foveal morphologic alterations in preterm and term-born children using a modified fundus-controlled perimeter and spectral domain-optical coherence tomography (SD-OCT) imaging.
Methods:
We performed fundus-controlled chromatic dark adaptometry in premature children aged 6 to 13 years without retinopathy of prematurity (no-ROP; n = 61) and with spontaneously regressed ROP (sr-ROP, n = 29), and in 11 age-matched term-born children. The degree of macular developmental arrest (MDA), defined as a disproportion of the outer nuclear layer to inner retinal layers in the fovea (ONL+/IRL-ratio), was analyzed with the DiOCTA tool in SD-OCT scans.
Results:
Children with MDA showed a flatter dark adaptation course progression with a significant rod-mediated sensitivity recovery delay (0.0113 vs. 0.0253 dB/s; P < 0.001). Preterm-born children with regular foveal morphology reached the final rod-mediated dark-adapted threshold at 12 minutes after bleach at 18.8 dB, compared to after 18.7 minutes at 17.6 dB in children with MDA (no significant difference in final threshold; P = 0.773). The cone-mediated dark adaptation progression showed a significant lower final threshold in children with MDA (6.0 vs. 8.1 dB; P = 0.004).
Conclusions:
Changes in dark adaptation were seen in the presence of MDA observed in premature children in the no-ROP and sr-ROP groups. MDA in former premature children is associated with functional deficits of cone and rod photoreceptor visual pathways.
Translational Relevance:
Morphologic alterations in the central retina of premature children, evident in SD-OCT, are associated with long-term functional deficits in the rod and cone pathways, particularly evident in the rod dark adaptation course measured at 12° eccentricity. This indicates a more widespread retinal functional pathology not limited to the fovea, but occurring together with foveal alterations best defined as MDA.
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