Ocular outcomes and comorbidities in preterm infants enrolled for retinopathy of prematurity screening: A cohort study from western India

Abstract

BACKGROUND:Retinopathy of prematurity (ROP) is emerging as an important cause of childhood blindness in middle-income countries such as India. Although blindness can be prevented in most cases with timely screening and treatment, certain ocular comorbidities can lead to visual impairment. We evaluated and compared 1-year visual, refractive, and structural outcomes and comorbidities in three subsets of preterm infants enrolled for screening of ROP.SUBJECTS AND METHODS:Preterm children enrolled in the hospital's ROP screening program and with diagnosis of no ROP, mild ROP, or severe ROP were followed at 1 year of age to evaluate and compare visual, refractive, and structural outcomes as well as the presence of ocular comorbidities. Risk of poor outcome was calculated in children with mild and severe ROP reference population being children without ROP.RESULTS:Eyes with severe ROP were at highest risk of poor visual (risk ratio [RR]: 3.5, P < 0.001), refractive (RR: 45, P < 0.001), and structural (RR: 11, P = 0.006) outcome as well as ocular comorbidities (RR 11, P < 0.001). Eyes with mild ROP were at higher risk of myopia (RR: 11, P = 0.06) and ocular comorbidities (RR: 4, P = 0.04). Sixteen (16%) of the eyes without ROP developed poor visual outcome.CONCLUSION:Eyes with severe ROP are at highest risk of poor ocular outcomes and comorbidities and need a long-term follow-up. Eyes which do not develop ROP can have poor visual outcome and need to be assessed within the 1st year of life.

Retinopathy of prematurity in India – what can we learn from the polio legacy?

“… 83 , 84 Significant refractive errors are more common in infants with severe ROP than in those with no or mild ROP. 85 Studies comparing intravitreal anti-VEGF agents (e.g., bevacizumab and ranibizumab) with conventional lasers have shown that refractive errors are more common after laser treatment. 86 , 87 Overall, these data emphasize the importance of continual monitoring and timely intervention for vision problems in infants with significant ROP.…”

Myopia in India

“…Clinical Ophthalmology 2022:16 166 retinopathy of prematurity (ROP), both in mild and severe cases. [48][49][50] The risk of developing myopia increased with increased clock hours of ROP, the higher number of laser spots, and prolonged regression times. [49][50][51] Some authors found myopia to be more common in laser-treated eyes as compared to the spontaneously regressed ROP cohorts, with cicatricial retinopathy hypothesized to be a risk factor in laser-treated eyes.…”

“…[48][49][50] The risk of developing myopia increased with increased clock hours of ROP, the higher number of laser spots, and prolonged regression times. [49][50][51] Some authors found myopia to be more common in laser-treated eyes as compared to the spontaneously regressed ROP cohorts, with cicatricial retinopathy hypothesized to be a risk factor in laser-treated eyes. [52][53][54] In addition, the altered role of neuroectodermal components in ROP has been proposed to be a risk factor.…”

Long-term Visual and Refractive Outcomes of Argon Laser-treated Retinopathy of Prematurity

“…[1,2] Treatments including cryotherapy and diode laser therapy have been efficacious in preventing the progression of the disease as well as decreasing the incidence of severe ocular complications such as retinal detachment and eventual visual loss. [3][4][5] Since about 1990, diode laser photocoagulation has been considered a therapeutic option with better visual outcomes than cryotherapy. [6] Furthermore, argon laser therapy has also been used for patients with threshold ROP for about two decades.…”