Abstract

Background: Prematurity by itself carries a lifelong increased risk of ocular morbidity, regardless of whether the baby developed acute phase ROP. When visual acuity and contrast sensitivity are measured later in life for children born prematurely compared to term birth, median values are significantly lower. Prematurity can later lead to sequelae which is mainly divided into 4 categories; visual functions, strabismus, refractive errors mainly myopia and those affecting the ocular structure like retinal detachment, glaucoma, cataract.

Thus we can infer that, ROP as such is not preventable but the blindness from ROP is one of the few causes of childhood visual disability in which blindness should, by timely treatment, be prevented. There is also need for long term follow up of these children to detect any sequelae.

Materials and methods- Prospective consecutive case series of preterm infants screened for ROP at a tertiary eye care center over a period of 2 years.

Results- Refractive errors occurred more frequently in the premature babies as compared to the general population. Among refractive errors, myopia predominated in all groups. The prevalence of refractive errors and the degree of myopia were significantly affected by the presence of ROP, everity of ROP, decreasing birth weight and gestational age. Astigmatism also occurred more frequently in the ROP group. Degree of astigmatism was also higher in the ROP group as copared to the premature babies without ROP.

Among other problems affecting ocular structure, Strabismus had a significant association to the presence of ROP. All other sequelae like cataract, nystagmus, retinal detachment and anterior segment problems were only seen in the cicatricial ROP group.

Conclusions- This study stresses the need for early screening of premature babies for the presence of refractive errors and other problems of ocular structure like strabismus, nystagmus, cataract which can enable these babies to have a normal visual development especially in developing countries where there is a rise in neonatal services.

Key Words – Prematurity, Retinopathy of prematurity, Strabismus, Refractive errors.

1.      Birch EE, O'Connor AR. Preterm birth and visual development. Semin Neonatol. 2001 Dec;6(6):487-97.

2.      Fledelius HC. Ophthalmic changes from age of 10 to 18 years. A longitudinal study of sequels to low birth weight. II. Visual acuity. Acta Ophthalmol (Copenh). 1981 Feb;59(1):64-70.

3.      Sebris SL, Dobson V, Hartmann EE. Assessment and prediction of visual acuity in 3- to 4-year-old children born prior to term. Hum Neurobiol. 1984;3(2):87-92.

4.      Dobson V, Quinn GE, Abramov I, Hardy RJ, Tung B, Siatkowski RM, et al. Color vision measured with pseudoisochromatic plates at five-and-a half years in eyes of children from the CRYO-ROP study. Invest Ophthalmol Vis Sci. 1996 Nov;37(12):2467-74.

5.      Gupta VP, Dhaliwal U, Sharma R, Gupta P, Rohatgi J. Retinopathy of prematurity--risk factors. Indian J Pediatr. 2004 Oct;71(10):887-92.

6.      Aggarwal R, Deorari AK, Azad RV, Kumar H, Talwar D, Sethi A, et al. Changing profile of retinopathy of prematurity. J Trop Pediatr. 2002 Aug;48(4):239-42.

7.      Maheshwari R, Kumar H, Paul VK, Singh M, Deorari AK, Tiwari HK. Incidence and risk factors of retinopathy of prematurity in a tertiary care newborn unit in New Delhi. Natl Med J India. 1996 Sep-Oct;9(5):211-4.

8.      Darlow BA. Incidence of retinopathy of prematurity in New Zealand. Arch Dis Child. 1988 Sep;63(9):1083-6.

9.      Chan-Ling T, Gock B, Stone J. The effect of oxygen on vaso formative cell division. Evidence that 'physiological hypoxia' is the stimulus for normal retinal vasculogenesis. Invest Ophthalmol Vis Sci. 1995 Jun;36(7):1201-14.

10.  Holmstrom G, el Azazi M, Kugelberg U. Ophthalmological follow up of preterm infants: a population based, prospective study of visual acuity and strabismus. Br J Ophthalmol. 1999 Feb;83(2):143-50.

11.  Nissenkorn I, Yassur Y, Mashkowski D, Sherf I, Ben-Sira I. Myopia in premature babies with and without retinopathy of prematurity. Br J Ophthalmol. 1983 Mar;67(3):170-3

12.  Quinn GE, Dobson V, Kivlin J, Kaufman LM, Repka MX, Reynolds JD, et al. Prevalence of myopia between 3 months and 5 1/2 years in preterm infants with and without retinopathy of prematurity. Cryotherapy for Retinopathy of Prem-aturity Cooperative Group. Ophthalmol-ogy. 1998 Jul;105(7):1292-300.

13.  O'Connor AR, Stephenson TJ, Johnson A, Tobin MJ, Ratib S, Fielder AR. Strabismus in children of birth weight less than 1701 g. Arch Ophthalmol. 2002 Jun;120(6):767-73.

14.  Katoch D, Sanghi G, Dogra MR, Beke N, Gupta A. Structural sequelae and refra-ctive outcome 1 year after laser treatment for type 1 prethreshold retinopathy of prematurity in Asian Indian eyes. Indian J Ophthalmol. 2011 Nov-Dec;59(6):423-6.

15.  Dhawan A, Dogra M, Vinekar A, Gupta A, Dutta S. Structural sequelae and refractive                   outcome after successful laser treatment for threshold retinopathy of prematurity. J      Pediatr Ophthalmol Strabismus. 2008 NovDec;45(6):356-        61.

16.  McLoone EM, O'Keefe M, McLoone SF, Lanigan BM. Long-term refractive and biometric outcomes following diode laser therapy for retinopathy of prematurity. J Aapos. 2006 Oct;10(5):454-9.

17.  Keith CG, Kitchen WH. Ocular morbidity in infants of very low birth weight. Br J Ophthalmol. 1983 May;67(5):302-5.

18.  Snir M, Nissenkorn I, Sherf I, Cohen S, Ben Sira I. Visual acuity, strabismus, and amblyopia in premature babies with and without retinopathy of prematurity. Ann Ophthalmol. 1988 Jul;20(7):256-8.