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Updated: Aug 10, 2026
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Longitudinal Choroidal Development in Preterm Infants
Suzanne M Michalak1,2, Shwetha Mangalesh1, Yineng Chen3
1Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina.
Insights
Subfoveal choroidal thickness in preterm infants grows rapidly until 38 weeks postmenstrual age (PMA), then growth nearly stops. Extremes in birth weight and prematurity significantly impact this crucial ocular development.
Area of Science:
- Ophthalmology
- Neonatology
- Developmental Biology
Background:
- Preterm infants are at increased risk for ocular abnormalities.
- Choroidal development is critical for retinal health and visual function.
- Understanding normative choroidal growth in preterm infants is essential for identifying potential complications.
Purpose of the Study:
- To characterize the changes in subfoveal choroidal thickness in preterm infants.
- To establish normative values for choroidal thickness from 30 to 60 weeks' postmenstrual age (PMA).
- To analyze the rate of choroidal growth during this period.
Main Methods:
- A prospective, observational study (BabySTEPS) enrolled preterm infants.
- Handheld optical coherence tomography (OCT) was used for imaging.
- Custom software measured subfoveal choroidal thickness, with manual correction.
Main Results:
- Choroidal growth followed a biphasic model: linear growth from 30 to 38.4 weeks PMA (14.8 μm/week), followed by near cessation.
- Mean choroidal thickness at 30 weeks PMA was 141.4 μm, increasing to 306.2 μm by 56-60 weeks PMA.
- Infants with extremely low birth weight and extremely preterm infants showed significantly slower initial growth rates.
Conclusions:
- Preterm infant choroidal thickness exhibits rapid linear growth until approximately 38 weeks PMA, after which growth significantly slows.
- These findings provide foundational data on choroidal development in preterm infants.
- Understanding the impact of prematurity and low birth weight on choroidal development is vital for assessing ocular and retinal health.
Purpose:
To characterize changes in subfoveal choroidal thickness in preterm infants from 30 to 60 weeks' postmenstrual age (PMA).
Design:
The prospective, observational Study of Eye Imaging in Preterm infantS (BabySTEPS) enrolled infants eligible for retinopathy of prematurity screening per the American Association of Pediatrics guidelines.
Subjects:
Infants imaged with an investigational, handheld OCT at ≥ 4 distinct imaging sessions between 30 to 60 weeks' PMA as part of BabySTEPS.
Methods:
Average choroidal thickness across the central subfoveal 1 mm in each eye at each time point was measured using custom segmentation software, and errors were manually corrected by a trained grader. We prospectively collected birth history data. A segmented mixed model was used to analyze the change in choroidal thickness as a function of PMA, birth weight, and gestational age (GA).
Main Outcome Measures:
Characterization of normative subfoveal choroidal thickness values and choroidal growth rate between 30 to 60 weeks' PMA.
Results:
We included 592 imaging sessions of 79 preterm infants (152 eyes). Mean (± standard deviation) GA was 27.5 ± 2.5 weeks. Mean choroidal thickness was 141.4 ± 34.5 μm at 30 weeks, 272.2 ± 83.9 μm at 38 weeks, and 306.2 ± 77.4 μm between 56 and 60 weeks. Between 30 and 60 weeks' PMA, choroidal growth followed a biphasic model, with a linear growth rate of 14.8 μm per week (95% confidence interval [CI], 13.6-16.0) from 30 until 38.4 weeks, then cessation of growth, with a growth rate of 0.3 μm per week (95% CI, -1.1 to 1.6) from 38.4 to 60 weeks. Infants with extremely low birth weight (ELBW; < 1000 g) and extremely preterm (GA < 28 weeks) infants had significantly slower initial growth rates compared with very low and low birth weight and very preterm and preterm infants (ELBW 13.0 vs. 21.0 μm per week; P < 0.0001 and extremely preterm 13.2 vs. 18.0 μm per week; P = 0.003).
Conclusions:
Preterm infant choroidal thickness experiences rapid linear growth from 30 to 38 weeks' PMA, at which time growth nearly stops. These foundational measurements and identification of the impact of extremes of low birth weight and prematurity on choroidal development will be essential as researchers begin to understand the role of choroidal development in ocular and retinal health in human infants.
Financial Disclosures:
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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