A new study shows that cerebral damage – rather than Retinopathy of Prematurity (ROP) – could be the primary risk factor of visual impairment among extremely preterm children.
Among children born before 28 weeks’ gestation, cerebral damage and two measures of advanced retinal disease – moderate-to-severe foveal abnormality and a history of treatment for retinopathy of prematurity – were independently associated with visual impairment (P<0.05 for all), according to Dr. Carina Slidsborg of Copenhagen University Hospital, and colleagues.
The results of the Danish study have been reported online in Archives of Ophthalmology.
“This raises concerns that, in the current clinical ophthalmologic setting, retinopathy of prematurity sequelae are given too much importance, and cerebral damage is given too little importance when attributing the cause of visual impairment,” the study authors wrote.
In later infancy when visual function is developing and is more accurately assessable
“The clinical implications for these results should be that paediatric ophthalmologists and paediatricians look beyond retinopathy of prematurity and consider cerebral damage in all premature infants, even in cases in which blindness or visual impairment may be explained by the current retinopathy of prematurity sequelae,” they wrote.
“Detection of cerebral damage and cerebral visual impairment in extremely preterm children allows referral to multidisciplinary teams specialising in clinical assessment and rehabilitation,” the study authors said.
Australian Reaction
West Australian ophthalmologist Professor Geoffrey Lam welcomed the study findings.
“For years we have been suspecting that there is something other than prematurity preventing the extreme premature babies achieving perfect vision. It is good to see confirmation from this study that there are three possible factors: global developmental deficits, moderate-to-severe foveal abnormality, and retinopathy of prematurity treatment were all significantly associated with visual impairment,” he said.
“I often say to parents that I suspect that the developmental issues with the premature babies are affecting the sight. This Danish study has confirmed this.”
He said long term follow up of the Cryotherapy for ROP trials have also supported the notion that treatment contributes to somewhat less perfect vision.
Sydney ophthalmologist Jeremy Smith said the findings were “logical in that extreme preterm infants that survive have considerable neurological comorbidity which can influence visual function independent of Retinopathy of Prematurity”.
“The basic substrate of vision is normal attached retina which is of course where ROP screening and timely therapeutic intervention are critical in the early months of a pre-term neonate’s life,” said Dr. Smith.
“In later infancy when visual function is developing and is more accurately assessable, paediatric ophthalmologists are acutely aware of cortical disease and its effect on vision, such as amblyopia management, general neurological impairment and cognitive deficit and address these issues in consultation with the child’s paediatrician,” he said.
