Refractive, sensory, and biometric outcome among retinopathy of prematurity children with a history of laser therapy: A retrospective review from a tertiary care center in South India

Abstract

Purpose: Ocular morbidities like high refractive error, strabismus, and amblyopia are common among laser-treated retinopathy of prematurity children (ROP). Long-term optical status and refractive outcomes including the sensory outcomes were less investigated in these children from this region. The purpose of our study is to evaluate the long-term outcome (refractive, biometric profile, sensory) of treatment for ROP using laser. Methods: This study is a retrospective, cross-sectional, observational, and intervention research among 6–15-year-old children who underwent laser for ROP with a minimum of 6-year follow-up. Results: Eighty lasered eyes of 41 children were assessed. Mean age was 9.71 years (±3.39). Seventy-three eyes (91.2%) achieved visual acuity better than 20/40. The mean visual acuity in LogMAR was 0.18 (20/30). The mean spherical equivalence was −5.29 D ± 4.9. Mean astigmatism measured was −1.53 DC (range: +0.50 DC to −4.5DC). Fifty-three eyes (66.25%) had significant astigmatism. The mean axial length was 23.5 ± 1.35 (21–26) mm. Mean lens thickness was 3.76 ± 0.30 (3.03–4.34) mm. Correlation analysis among the low and high spherical equivalent group signified that axial length ( P value = 0.001), visual acuity ( P value = 0.0002), and myopic shift ( P value = 0.0006) were found to be statistically significant. Stereopsis better than 480 s of arc for near was observed in 41% children. Structural posterior pole sequelae developed in 3 eyes (3.75%). Conclusion: A significant number of children with high myopia, astigmatism, and strabismus had satisfactory visual outcome observed at long-term follow-up after treatment for ROP using laser. Our study revealed that myopia was influenced by an increase in axial length than the lens thickness.

Commentary: Functional outcome after successful laser for retinopathy of prematurity – Where we stand?

“…Most of the studies report satisfactory long visual outcomes. Despite this, fine stereopsis was seen in only 15.6% patients by Anilkumar et al [6] Similar results of lack of stereopsis were concluded by Bonotto et al [8] It emphasizes the need for regular assessment and early identification of associated refractive error, amblyopia, and strabismus and a prompt intervention.…”

“…Myopia observed by Anilkumar et al was found to be associated with higher axial length, but unlike other studies, there was no association with lenticular thickness. [6] Kaur et al found higher myopia was associated with higher lenticular thickness and axial length at 1-year postnatal age. [7] Various studies have discussed factors associated with occurrence of myopia in eyes with history of laser for ROP, the exact mechanism of its development is still controversial.…”

“…[7] Various studies have discussed factors associated with occurrence of myopia in eyes with history of laser for ROP, the exact mechanism of its development is still controversial. [567] This may be because most of these studies are retrospective, cross-sectional studies, and lack of documentation of progression of myopia and serial measurement of biometric parameters. Moreover, it is difficult to ascertain whether the resultant myopia is due to severe ROP or laser.…”

“…Around one-third of the children develop strabismus as reported by a study in this issue, possibly due to amblyopia and associated refractive errors. [6] Prematurity is a known independent risk factor for development of strabismus and these children require regular follow-up during their early years.…”

Commentary: Continuation of care - Refraction beyond regression

“…In the article “Refractive, Sensory and Biometric outcome among ROP children with a history of laser therapy- A Retrospective review from a tertiary care centre in South India”, the authors highlight the long term refractive concerns in babies successfully treated for ROP. [3] Certain delayed complications such as cataract, glaucoma and retinal detachment, in addition to refractive errors and strabismus necessitate lifelong follow-up of babies treated for ROP. A baby successfully treated for ROP can still have suboptimal visual outcomes if refractive errors go uncorrected or if secondary complications are not addressed.…”