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Functional Ophthalmic Factors Associated With Extreme Prematurity in Young Adults

Saurabh Jain¹, Peng Yong Sim^1,2, Joanne Beckmann³

¹Ophthalmology Department, Royal Free London NHS Foundation Trust, London, United Kingdom.

JAMA Network Open

|January 28, 2022

Insights

Young adults born extremely preterm (EP) face higher risks of visual impairment and ocular morbidities, including strabismus and nystagmus. These deficits appear largely independent of retinopathy of prematurity (ROP) status in infancy.

Area of Science:

Ophthalmology
Neonatology
Developmental Pediatrics

Background:

Children born preterm (<37 weeks' gestation) have increased risks of visual impairment.
Long-term ocular outcomes in adulthood for extremely preterm (EP) infants, particularly those with high retinopathy of prematurity (ROP) risk, are not well understood.

Purpose of the Study:

To assess visual function and ocular morbidity in young adults born EP compared to full-term controls.
To investigate the relationship between neonatal ROP status and long-term visual outcomes in EP individuals.

Main Methods:

Prospective cohort study of 128 EP individuals (born 22-25 weeks' gestation) and 65 full-term controls at age 19.
Comprehensive eye examinations including visual acuity, refractive status, contrast sensitivity, color vision, ocular motility, and patient-reported visual function (Health Utilities Index Mark 3).

Main Results:

EP individuals had significantly worse best-corrected visual acuity and higher prevalence of strabismus, abnormal ocular motility, and nystagmus compared to controls.
No significant differences were found in refractive error, contrast sensitivity, color vision, or patient-reported visual function.
Visual and ocular deficits in EP individuals were observed regardless of neonatal ROP severity or treatment.

Conclusions:

Extreme prematurity is linked to persistent visual and ocular deficits into young adulthood.
These long-term visual impairments in EP individuals appear to be partly independent of neonatal retinopathy of prematurity.
Ophthalmologists should monitor EP individuals for visual and ocular complications throughout their lives.

Read full analysis

Abstract

Importance:

Children born preterm (<37 weeks' gestation) have a higher risk of visual impairment and ocular morbidities compared peers born at full term. However, the long-term ocular sequelae in adulthood for those born extremely preterm (EP), who have the highest risk of neonatal retinopathy, are unknown.

Objective:

To evaluate visual function and ocular morbidity in young adults born EP compared with controls born full term.

Design, Setting, And Participants:

This prospective cohort study of a geographically based birth cohort in the UK and Ireland born from March 1 through December 31, 1995, included 128 participants aged 19 years (born at 22-25 weeks' gestation) and 65 age-matched controls born at full term. Statistical analysis was performed from March 1, 2020, to November 26, 2021.

Exposures:

Participants underwent eye examinations as part of a comprehensive outcome evaluation.

Main Outcomes And Measures:

Best-corrected visual acuity, refractive status, contrast sensitivity, color vision, prevalence of strabismus and nystagmus, and patient-reported visual function, measured using the Health Utilities Index Mark 3.

Results:

The study comprised 128 participants (256 eyes; 68 female participants [53%]; mean [SD] age, 19.3 [0.5] years) and 65 age-matched controls born at full term (130 eyes; 40 female participants [62%]; mean [SD] age, 19.2 [0.5] years). Compared with control eyes, the mean (SD) best-corrected visual acuity among eyes in the EP group was significantly worse (monocular vision: -0.06 [0.14] logMAR in the control group vs 0.14 [0.38] logMAR in the EP group; P < .001; binocular vision: -0.14 [0.15] logMAR in the control group vs 0.06 [0.37] logMAR in the EP group; P < .001). Participants in the EP group had a significantly higher prevalence of strabismus (36% [46 of 127] vs 0%; P < .001), abnormal ocular motility (15% [19 of 125] vs 0%; P < .001), and nystagmus (13% [16 of 127] vs 0%; P < .001) than the control group. No significant differences between participants in the EP group and controls were observed for refractive error, contrast sensitivity, color vision, or patient-reported visual function. Among the participants in the EP group, 48% of eyes (120 of 250) had no retinopathy of prematurity (ROP), 39% (98 of 250) had ROP not requiring neonatal treatment, and 13% (32 of 250) received cryotherapy or laser ablation for ROP. Within the EP group, there was no significant difference in binocular visual function parameters, prevalence of ocular morbidity, and patient-reported visual function by neonatal ROP status.

Conclusions And Relevance:

Extreme prematurity is associated with an increased prevalence of visual and ocular deficits in young adulthood; this study suggests that, for individuals born EP, visual and ocular deficits appear to be partially independent of ROP status in the neonatal period but reports similar overall visual function.

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