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Changing pattern of retinopathy of prematurity: a 37-year clinic experience
A H Hoon1, J E Jan, M F Whitfield
1Department of Paediatrics, University of British Columbia, Vancouver, Canada.
Insights
Retinopathy of prematurity (ROP) causes blindness in infants. This study tracked ROP-related visual impairment in children over 37 years, finding it affects smaller, less mature infants over time.
Area of Science:
- Ophthalmology
- Neurodevelopmental Pediatrics
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Historically, ROP affected more mature infants, but medical advancements have shifted the affected population towards smaller, premature infants.
- Understanding the long-term neurodevelopmental outcomes and associated handicaps in ROP is crucial for early intervention.
Purpose of the Study:
- To analyze changes in perinatal characteristics of infants with ROP over a 37-year period.
- To evaluate the spectrum of associated neurodevelopmental handicaps in children with ROP-induced blindness.
- To identify trends in ROP incidence and severity in relation to infant maturity.
Main Methods:
- Retrospective analysis of multi-disciplinary neurodevelopmental assessments.
- Inclusion of 70 children legally blind due to cicatricial retinopathy of prematurity.
- Data collection spanning 37 years (1951-1987) from British Columbia.
Main Results:
- ROP has increasingly affected smaller and less mature infants, particularly those under 1,000g birth weight since 1981.
- A higher incidence of mild spastic diplegia was observed in infants born after 1980.
- Despite decreasing birth weights and gestational ages, the proportion of ROP patients with no other associated handicaps remained stable at approximately 30% across decades.
Conclusions:
- The profile of infants affected by ROP-induced blindness has significantly shifted towards extreme prematurity.
- While ROP is now primarily seen in very low birth weight infants, the rate of associated handicaps has not decreased.
- Continued vigilance and comprehensive neurodevelopmental follow-up are essential for infants with ROP.
Abstract:
A retrospective analysis was done of multi-disciplinary neurodevelopmental assessments in 70 children who were legally blind because of cicatricial retinopathy of prematurity. The subjects lived in British Columbia and were born during a 37-year period between 1951 and 1987. The purpose of the study was to investigate changes in the perinatal characteristics and to evaluate the associated handicaps. All patients were assessed at least once in the Visually Impaired Program, British Columbia Children's Hospital. In the majority, the visual loss was profound. Since 1951, blinding retinopathy of prematurity has become a disease of progressively smaller and less mature infants. Since 1981, it has been almost entirely confined to infants of birth weight less than 1,000 g in British Columbia. The diagnosis of mild spastic diplegia was made more commonly in patients born after 1980 but, despite the progressive reduction in birth weight and gestational age during the study period, the number of patients without other associated handicaps remained constant (approximately 30%) during each successive decade.