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Longitudinal Analysis of Refractive Errors in Premature Children during the First Three Years of Life
Lauren Hennein1, Alejandra de Alba Campomanes1
1Department of Ophthalmology, University of California San Francisco , San Francisco, California.
Insights
Refractive errors like with-the-rule astigmatism and spherical equivalent decrease in premature children during the first three years. Screening premature infants for vision issues around 18-24 months is recommended.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Refractive Error Development
Background:
- Premature infants are at higher risk for refractive errors.
- Longitudinal data on refractive error changes in premature infants is crucial for timely intervention.
- Understanding refractive error trajectories informs screening protocols.
Purpose of the Study:
- To track refractive error changes in premature infants over the first three years.
- To compare refractive error behavior in retinopathy of prematurity (ROP) and non-ROP screened infants.
- To identify optimal screening intervals for high-risk premature infants.
Main Methods:
- Retrospective cohort study of premature infants (<37 weeks gestational age).
- Analysis of cycloplegic refractions converted into power vectors (M, J, J45).
- Multilevel mixed-effects linear regression models used to analyze longitudinal changes.
Main Results:
- Spherical equivalent (M) decreased by 1.13 diopters over three years.
- With-the-rule astigmatism (J) decreased by 0.64 diopters over three years.
- The rate of change in J and M was lowest at 24 months, stabilizing after 18 months.
Conclusions:
- With-the-rule astigmatism and spherical equivalent show a decreasing trend in the first three years of life.
- With-the-rule astigmatism is a significant contributor to amblyogenic refractive errors in this population.
- Screening premature infants around 18-24 months may be appropriate given the observed refractive error stabilization.
Purpose:
To examine the longitudinal behavior of refractive errors in both retinopathy of prematurity (ROP) and non-ROP screened premature children during the first three years of life.
Methods:
This retrospective cohort included premature children (less than 37 weeks gestational age) born between 10/2011 and 8/2013 with ≥ two cycloplegic refractions. Cycloplegic refractions were converted into power vectors: M (spherical equivalent), J [positive for with-the-rule (WTR) and negative for against-the-rule (ATR) astigmatism], and J 45 (oblique astigmatism). Each power vector component was fitted by multilevel mixed-effects linear regression models; the mean change over time was analyzed.
Results:
Mean J was 0.59 (95% CI 0.53-0.66) at six months and 0.29 (95% CI 0.19-0.39) at 18 months; afterward, the change was <0.1 per year. J decreased -0.32 (0.64 diopters) over three years. When analyzed in one-year increments, the mean change in J and M was lowest at 24 months. M decreased 1.13 diopters over three years.
Conclusion:
WTR astigmatism and spherical equivalent decreased over the first three years of life. WTR astigmatism accounted for the majority of amblyopogenic refractive errors. The change in J leveled after 18 months and the lowest rate of change was at 24 months in J and M, thus it may be appropriate to screen this high-risk population around 18-24 months.
