Effects of retinopathy of prematurity and preterm birth on childhood visual outcomes.

Clinical relevance: Late-childhood visual outcomes in children born preterm, with or without retinopathy of prematurity (ROP), are not well understood, limiting the opportunities for preventative and early interventions.

Background: This observational study investigated how ROP and preterm birth may affect late-childhood visual outcomes.

Methods: Children born at gestational age <30 weeks or birth weight <1250 grams and screened for ROP, and at full-term (gestational age ≥ 37 weeks) were assessed at 8-10 years corrected age. The primary outcome, favourable overall visual outcome (good presenting vision in the better eye [≤0.30 logMAR], no strabismus, passing stereoacuity, not requiring spectacles), and other outcomes were compared using generalised linear regression models.

Results: The study included 111 children (ROP n = 47 [stages: 1 = 23, 2 = 19, 3 = 4, 4 or worse = 1; 3 laser photocoagulation treatment]; preterm birth and no ROP n = 17; and term n = 37), aged 8.9 (interquartile range 8.6, 9.4) years. There were no significant differences in favourable overall visual outcome (composite measure) between the groups (ROP, 21/44 (48%); preterm birth and no ROP, 8/14 (57%); term, 20/32 (63%); p = 0.43). Children with ROP had shorter axial length (p = 0.01) and steeper corneal curvature (p = 0.001) than the term group; both preterm groups had thicker central retinas than the term group (p < 0.0001). The term group had better visuomotor integration scores than the ROP group (p = 0.01). No group differences in global motion or electrophysiology were observed.

Conclusion: In this small observational cohort, children with mainly mild ROP had similar visual outcomes to children born preterm without ROP and at full-term but remain at risk of reduced visuomotor integration in late childhood. Children born preterm are at risk of ocular structural changes, but further investigation is required to understand the long-term implications.