Fundus-Controlled Dark Adaptometry in Young Children Without and With Spontaneously Regressed Retinopathy of Prematurity

Abstract

Purpose: We correlate dark adaptation course with foveal morphologic alterations in preterm and term-born children using a modified fundus-controlled perimeter and spectral domain-optical coherence tomography (SD-OCT) imaging. Methods: We performed fundus-controlled chromatic dark adaptometry in premature children aged 6 to 13 years without retinopathy of prematurity (no-ROP; n ¼ 61) and with spontaneously regressed ROP (sr-ROP, n ¼ 29), and in 11 age-matched term-born children. The degree of macular developmental arrest (MDA), defined as a disproportion of the outer nuclear layer to inner retinal layers in the fovea (ONLþ/ IRL-ratio), was analyzed with the DiOCTA tool in SD-OCT scans. Results: Children with MDA showed a flatter dark adaptation course progression with a significant rod-mediated sensitivity recovery delay (0.0113 vs. 0.0253 dB/s; P , 0.001). Preterm-born children with regular foveal morphology reached the final rodmediated dark-adapted threshold at 12 minutes after bleach at 18.8 dB, compared to after 18.7 minutes at 17.6 dB in children with MDA (no significant difference in final threshold; P ¼ 0.773). The cone-mediated dark adaptation progression showed a significant lower final threshold in children with MDA (6.0 vs. 8.1 dB; P ¼ 0.004). Conclusions: Changes in dark adaptation were seen in the presence of MDA observed in premature children in the no-ROP and sr-ROP groups. MDA in former premature children is associated with functional deficits of cone and rod photoreceptor visual pathways. Translational Relevance: Morphologic alterations in the central retina of premature children, evident in SD-OCT, are associated with long-term functional deficits in the rod and cone pathways, particularly evident in the rod dark adaptation course measured at 128 eccentricity. This indicates a more widespread retinal functional pathology not limited to the fovea, but occurring together with foveal alterations best defined as MDA.

Melatonin protects inner retinal neurons of newborn mice after hypoxia‐ischemia

“…3 Despite the availability of this therapy, many children with a history of ROP suffer visual impairment, including reduced visual acuity and deficient subtle color vision, 4 constricted visual field and contrast sensitivity, 5 and increased dark-adapted thresholds. 6 Moreover, human 7,8 and animal studies 9,10 have shown retinal dysfunction and structural abnormalities. The aforementioned evidence strongly implies that the neural retina is also affected by ROP.…”

Establishing Fully-Automated Fundus-Controlled Dark Adaptometry: A Validation and Retest-Reliability Study

“…Previously, Wadim Bowl and coworkers proposed the only other protocol for fundus-controlled dark adaptometry. 27 , 28 However, due to limitations of the MP1 microperimeter, their protocol necessitated adding filters to the optical path and changing the stimulus size during the examination to compensate for the low dynamic range. In addition, each test run had to be initiated manually, and no inter-device validation or retest reliability data were published for their method.…”

“…To address these shortcomings, using the MP1 device has been proposed for fundus-controlled dark adaptometry. 27 , 28 However, due to the limited dynamic range of the device, this method necessitated adding optical filters and changing the stimulus size within test runs. Additionally, the workflow was also not fully automated, hindering its application in multicenter therapeutic trials.…”

Neurosensory Alterations in Retinopathy of Prematurity: A Window to Neurological Impairments Associated to Preterm Birth

“…In line with this, most literature focuses on the mechanisms leading to neovascularization and the current therapeutic treatments are directed to the normalization of the retinal vasculature [ 99 ]. However, despite the effectiveness of these treatments or the spontaneous regression of the pathology, many children with a history of ROP experience persistent vision impairment, such as astigmatism and myopia [ 100 ], reduced visual acuity and deficient subtle color vision [ 101 ], constricted visual field and contrast sensitivity [ 102 ], and increased dark-adapted thresholds [ 103 ], along with structural retinal abnormalities [ 4 , 104 ]. Overall, these data suggest that some form of alteration in the development, viability, and function of neuroretinal cells (photoreceptors, retinal neurons and glia), may occur during ROP progression ( Figure 2 ).…”