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Risk factors and timing of ocular complications after screening for retinopathy of prematurity
Samantha X Xing1, Dylan K Kim1, Kriti Joshi Ojha2,3
1Columbia University Vagelos College of Physicians and Surgeons, 104 Haven Avenue, New York, NY, USA.
Insights
Nearly 25% of infants screened for retinopathy of prematurity (ROP) develop ocular complications, often within two years. Longer NICU stays increase this risk, highlighting the need for targeted follow-up care.
Area of Science:
- Ophthalmology
- Neonatal Care
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of childhood vision impairment.
- Long-term complications like strabismus, amblyopia, and glaucoma can arise from ROP.
- Identifying high-risk infants and optimal follow-up schedules is crucial due to a shortage of pediatric ophthalmologists.
Purpose of the Study:
- To identify predictors of ocular complications after ROP resolution.
- To determine the optimal timing and frequency for pediatric ophthalmology follow-up visits.
- To inform risk-stratified surveillance strategies for infants screened for ROP.
Main Methods:
- Retrospective review of 223 infants screened for ROP (2018-2021).
- Analysis of ocular complication development, type, and timing post-ROP clearance.
- Logistic regression and Kaplan-Meier analysis to identify risk factors and time to onset.
Main Results:
- 54 out of 223 infants (24.2%) experienced ocular complications.
- Most common complications included refractive error (17.0%), strabismus (13.9%), and amblyopia (4.5%).
- Longer neonatal intensive care unit (NICU) stay was an independent predictor of complications (OR 1.30, p=0.022).
Conclusions:
- Approximately 24% of infants screened for ROP develop subsequent ocular complications.
- Complications typically manifest within two years of ROP resolution.
- NICU length of stay is a key predictor, emphasizing the need for risk-stratified follow-up to prevent vision loss.
Purpose:
Retinopathy of prematurity (ROP) remains a leading cause of childhood vision loss, often resulting in long-term complications such as strabismus, amblyopia, and glaucoma. Despite advances in screening, limited data exist on which infants are at highest risk and when these complications typically emerge-an important gap given the nationwide shortage of pediatric ophthalmologists. This study aimed to identify predictors of post-ROP ocular complications and determine the optimal timing and frequency of pediatric ophthalmology follow-up visits.
Methods:
We retrospectively reviewed 223 infants who underwent ROP screening between 2018 and 2021 and subsequently followed up with pediatric ophthalmology. The primary outcome was the development of ocular complications following ROP resolution, including their type and timing of detection. Univariate and multivariate logistic regression were used to identify independent risk factors, and Kaplan-Meier analysis assessed time to complication onset.
Results:
Of 223 infants, 54 (24.2%) developed at least one ocular complication. The most common were refractive error (17.0%), strabismus (13.9%), and amblyopia (4.5%). Most complications occurred within two years after ROP clearance. Strabismus was diagnosed earliest, followed by refractive error and amblyopia. Longer NICU stay was an independent predictor of ocular complications (OR 1.30, 95% CI 1.04-1.63; p = 0.022).
Conclusions:
Nearly one in four infants developed ocular complications after ROP screening, typically within the first two years. NICU length of stay independently predicted risk, supporting the need for risk-stratified surveillance to ensure timely detection, optimize resource allocation, and reduce preventable vision loss in infants screened for ROP.
