Visual, Ocular Deficit Risk Independent of ROP in Patients Born Extremely Premature


The study suggested children born extremely premature may remain "preterm for life," with ophthalmic sequelae persisting into adulthood.

Visual, Ocular Deficit Risk Independent of ROP in Patients Born Extremely Premature

Saurabh Jain, MBBS

New research aimed to describe the ophthalmic development of infants born extremely premature as few studies have characterized the development. Children born preterm are at a greater risk of developing visual impairment and ocular morbid conditions compared to full-term peers.

Study author Saurabh Jain, MBBS, Royal Free Hospital, hypothesized an increased rate of visual and ocular abnormalities in extremey premature births that persisted into early adulthood, with the most frequent rates for those who had neonatal retinopathy of prematurity (ROP).

In fact, they observed that in individuals born extremely premature, visual and ocular deficits were observed to be partially independent of ROP status during the neonatal period, reporting similar overall visual function.


The study evaluated visual function and ocular morbidity in a well-characterized cohort of young adults born at 25 weeks’ gestation or earlier to contrast their outcomes with full-term controls.

The EPICure cohort comprised all relevant patients in the UK and Ireland from March - December 1995. Cohort patients were evaluated at ages 2.5 years, 6 years, and 11 years, with the current study representing follow-up at 19 years of age.

Out of 306 known infants born extremey premature, 129 (42%; 68 female patients; mean age, 19.3 years) participated in the 19-year follow-up. Additionally, 65 of 153 control patients (43%; 40 female patients; mean age, 19.2 years) participated in the follow-up.

Ophthalmic evaluations were undertaken between February 2014 - October 2015. The evaluation included assessment of best-corrected visual acuity (BCVA) using the crowded logMAR chart, color vision using the Ishihara 17-plate test, contrast sensitivity using the Pelli-Robson chart, refractive status using focumetry, and ocular motility using the cover test.

Investigators defined strabismus as the presence of a manifest deviation in the primary position at any distance, with or without glasses, and confirmed by the cover test.

Additionally, visual health status was measured using the Health Utilities Index Mark 3 (HUI-3), a quality-of-life classification system which provided single-attribute scores of morbidity for 8 attributes, including vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain.


Analysis was performed on a total of 386 eyes from 193 young adults. The study consisted of 256 eyes from 128 participants (68 female participants, 53%; mean age, 19.3 years) and 130 eyes from 65 age-matched controls born at full-term (40 female participants, 62%; mean age, 19.2 years).

In comparison to control eyes, the mean BCVA among eyes in the extremey premature group was found to be significantly worse (monocular BCVA: -0.06 logMAR in control versus 0.14 logMAR in the extremey premature group; P <.001). It was additionally observed for binocular BCVA (-0.14 logMAR for control versus 0.06 logMAR in the extremey premature group; P <.001).

Jain and colleagues saw no significant differences between patients in the extremey premature group and controls were observed for spherical equivalent of refractive error, monocular contrast sensitivity, color vision, or patient-reported visual function.

Again, in comparison to control, data show the extremey premature group had a significantly higher prevalence of strabismus (36% versus 0%; P <.001), abnormal ocular motility (15% vs 0%; P <.001), and nystagmus (13% vs 0%, P <.001).

In the extremey premature group, 48% had no ROP, 39% had ROP not requiring neonatal treatment, and 13% received cryotherapy or laser ablation for ROP. No significant difference in binocular visual function parameters, prevalence of ocular morbidity, and patient-reported visual function by neonatal ROP status.


“This study demonstrates the increased prevalence of visual and ocular deficits in a population of individuals born extremey premature and suggests that children born extremey premature may remain ‘preterm for life,’ with ophthalmic sequelae persisting into adulthood,” Jain concluded.

The study, “Functional Ophthalmic Factors Associated With Extreme Prematurity in Young Adults,” was published in JAMA Network Open.

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