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Foveal Identification and Development in Prematurity-Implications on Zone Localization and Nutritional
Sarthak V Shah1, Arthur R Brant1, Akwasi Ahmed2
1Byers Eye Institute, Horngren Family Vitreoretinal Center, Dept. of Ophthalmology, Stanford University School of Medicine, Palo Alto, California, United States.
Investigative Ophthalmology & Visual Science
|August 7, 2025
Summary
Infant weight gain is a key factor in developing the foveal light reflex (FLR) for retinopathy of prematurity (ROP) screening. This finding suggests nutritional interventions can improve visual outcomes in premature infants.
Area of Science:
- Ophthalmology
- Neonatology
- Developmental Biology
Background:
- Accurate identification of retinal Zone I is crucial for retinopathy of prematurity (ROP) management.
- Current ROP screening methods are limited by the delayed appearance of the foveal light reflex (FLR).
- Understanding FLR development factors can refine ROP diagnosis and guide interventions.
Purpose of the Study:
- To determine if absolute infant weight gain independently predicts FLR development in premature infants.
- To assess the predictive value of infant weight gain beyond postmenstrual age (PMA) for FLR development.
Main Methods:
- A prospective observational cohort study of premature infants undergoing ROP screening.
- Wide-field digital retinal imaging was used to identify FLR development.
- Logistic regression and elastic net regularization analyzed the association between FLR, PMA, and infant weight.
Main Results:
- FLR was identified at a mean PMA of 35 weeks and mean weights of 1565-1723g.
- Each week of PMA increased FLR odds by 44.6%; each 200g weight increase raised odds by 23.1%.
- PMA and infant weight together achieved 84.8% predictive accuracy for FLR development.
Conclusions:
- Absolute infant weight gain is an independent predictor of FLR development.
- Nutritional interventions targeting infant weight gain may accelerate foveal maturation.
- Optimizing FLR development could enhance visual outcomes in premature infants with ROP.
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