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Incidence of Strabismus in Children With Retinopathy of Prematurity
Amr Almobayed1, Qais Dihan2, Adam K Cohen3
1From the Department of Ophthalmology (A.A., A.M.E.), Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, Florida, USA.
Insights
Children with retinopathy of prematurity (ROP) have a higher risk of developing strabismus, especially if they receive treatment. Strabismus incidence at 5 years was 34.78% in treated versus 22.14% in untreated ROP patients.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Strabismus is a common ocular misalignment that can affect visual development and binocularity.
- The relationship between ROP, its treatment, and the subsequent development of strabismus requires further elucidation.
Purpose of the Study:
- To estimate the cumulative incidence of strabismus in children diagnosed with retinopathy of prematurity (ROP).
- To compare strabismus incidence between treated and untreated ROP cohorts.
- To identify risk factors associated with strabismus development post-ROP diagnosis.
Main Methods:
- Retrospective cohort study involving children aged ≤18 years with ROP.
- Stratification into treated (laser or anti-VEGF) and untreated ROP groups.
- Kaplan-Meier analysis for cumulative incidence at 1, 3, and 5 years; Cox proportional hazards models for adjusted hazard ratios (aHR).
Main Results:
- The study included 27,720 ROP patients (973 treated, 26,747 untreated).
- Cumulative strabismus incidence at 5 years was 34.78% in treated ROP vs. 22.14% in untreated ROP.
- Treatment for ROP (aHR, 1.58) and comorbidities like amblyopia (aHR, 2.58) and nystagmus (aHR, 1.76) were independently associated with increased strabismus hazard.
Conclusions:
- Retinopathy of prematurity increases the risk of developing strabismus.
- Children undergoing treatment for ROP exhibit a higher cumulative incidence of strabismus.
- Early detection and management of strabismus are crucial in children with a history of ROP.
Purpose:
To estimate the cumulative incidence of strabismus among children diagnosed with retinopathy of prematurity (ROP).
Design:
Retrospective cohort study.
Methods:
Participants were children and adolescents aged ≤18 years with a diagnosis of ROP, with or without treatment exposure. We defined treated ROP as receipt of laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection, whereas untreated ROP had no record of either intervention. We estimated the cumulative incidence of strabismus at 1, 3, and 5 years after ROP diagnosis using Kaplan-Meier analysis. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHR) and 95% confidence intervals (CI), adjusting for demographic variables and ocular comorbidities. The main outcome measure was development of strabismus following ROP diagnosis.
Results:
The cohort included 27,720 ROP patients: 973 were treated, and 26,747 were untreated. cumulative incidence of strabismus was consistently higher among treated patients. At 5 years, cumulative incidence was 34.78% in treated patients compared with 22.14% in untreated patients, with esodeviations as the most common subtype, occurring in 22.35% of treated patients and 11.87% of untreated patients. Treatment exposure was independently associated with an increased hazard of strabismus (aHR = 1.58; 95% CI = 1.29-1.95; P < .001). Amblyopia (aHR = 2.58; 95% CI = 2.25-2.96; P < .001) and nystagmus (aHR = 1.76; 95% CI = 1.48-2.10; P < .001) were also independently associated with increased hazard.
Conclusions:
ROP confers an increased hazard of developing subsequent strabismus, with higher cumulative incidence among children who underwent treatment for ROP.
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