Visual acuity, amblyopia, and vision-related quality of life in preterm adults with and without ROP: results from the Gutenberg prematurity eye study

Abstract

This study investigated the effects of prematurity and ROP on visual acuity and VRQoL in adults (18-52 years). METHODS: The Gutenberg Prematurity Eye Study is a retrospective cohort study with a prospective ophthalmologic examination. Preterm and full-term participants at an age from 18 to 52 years were included. Distant corrected visual acuity (DCVA) and VRQoL were assessed in participants (892 eyes of 450 individuals aged 28.6 ± 8.6 years, 251 females) grouped into full-term controls (gestational age [GA] at birth ≥37 weeks), preterm participants without ROP and GA 33-36 weeks (group 2), GA 29-32 weeks (group 3), GA ≤ 28 weeks (group 4), non-treated ROP (group 5) and treated ROP (group 6). Main outcome measures were distant corrected visual acuity (DCVA), VRQoL and prevalence of amblyopia. RESULTS: The DCVA of the better eye correlated (p < 0.001) with GA, birth weight, ROP, ROP treatment, and perinatal adverse events and was poorer in both ROP groups. Visual acuity of <20/200 in the better eye was observed in two participants (4.2%) in the ROP group and one person (6.7%) in the treated ROP group. The prevalence of amblyopia increased in the ROP groups. Compared to full-term controls, visual functioning VRQoL scores were lower in preterm individuals independent of ROP while socioemotional VRQoL scores were only lower in the treated ROP group. CONCLUSION: Participants with postnatal ROP and its treatment showed decreased visual acuity and VRQol in adulthood, with amblyopia occurring more frequently in more preterm participants with ROP.

Ophthalmic sequelae of prematurity in late childhood and adulthood: A review

“…50 This outcome measure was worse in patients with a history of ROP with or without prior treatment compared to former preterm infants without history of ROP. 50 Prevalence of amblyopia was also greater among patients with a history of ROP with or without prior treatment compared to former preterm infants without history of ROP. 50 Though there is no available data on long-term visual acuity outcomes for ROP patients treated with anti-VEGF, a study by Rodriguez et al sought to assess childhood visual acuity in a cohort of such patients with promising results.…”

Does prematurity “per se” cause visual deficits in preterm infants without retinopathy of prematurity?

“…Some prenatal factors also appear to be associated with an increased risk for ROP (4), which in turn increases the risk for some AVO (5). There may also be prenatal factors that contribute to AVO among infants with ROP that are not mediated by ROP (6). If preterm birth "per se" is not a cause but a precondition for ROP and AVO, what are the prenatal (7) and postnatal (8) inducers of AOV in preterm infants without ROP (9)?…”

“…In another study, strabism was present in 12% of children up to 3 years of age who were born preterm, were screened between 2011 and 2018, and had no ROP [4]; the overall prevalence in a community setting is about 6% [5]. Another example is a study of adult individuals between 18 and 52 years born preterm (≤32 weeks GA) that reports a prevalence of amblyopia at examination of 10% among those without ROP, 24% in those with ROP, and only 2% in a term control group [6].…”

Augenärztliche Versorgung ehemaliger früh- und reifgeborener Personen im Erwachsenenalter – Ergebnisse der Gutenberg Prematurity Eye Study (GPES)

“…Unilaterale Amblyopie wurde definiert als bestkorrigierte Sehschärfe des schlechteren Auges ≤ 0,63 mit einem 2-Zeilen-Unterschied (Unterschied zwischen der Sehschärfe der beiden Augen von mindestens 2 Zeilen) oder ≤ 0,5 ohne einen solchen Unterschied und Schielen oder Schielen in der Vorgeschichte und/oder Anisometropie ≥ 1,0 dpt (sphärisch, zylindrisch, das schwächere Auge betreffend) und/oder keine anderen ophthalmologischen Anomalien, die das eingeschränkte Sehvermögen bei einem Teilnehmenden erklären. Bilaterale Amblyopie war definiert als bestkorrigierte Sehschärfe ≤ 0,63 auf beiden Augen und binokulare Hyperopie ≥ 4,0 dpt und/oder bilateraler Astigmatismus ≥ 2,0 dpt und/ oder bilaterale Myopie ≥ 6,0 dpt und/oder bilaterale Deprivation und keine anderen ophthalmologischen Anomalien, die eine eingeschränkte Sehfähigkeit erklären [10,18]. Teilnehmende mit Netzhautablösung, Katarakt und anderen sehbehindernden Augenkrankheiten, die mittels Spaltlampenuntersuchung festgestellt wurden, wurden als nicht amblyop eingestuft.…”

“…Die Autoren berichteten, dass frühgeborene Personen aufgrund einer reduzierten Sehschärfe häufiger Probleme bei Tagesaktivitäten gehabt hätten und seltener Auto gefahren sind [8]. In einer früheren Analyse der Gutenberg Prematurity Eye Study konnten wir erstmalig zeigen, dass v. a. extrem Frühgeborene mit postnataler ROP häufiger eine Amblyopie aufweisen [18]. Darüber hinaus können wir zeigen, dass 57 % der frühgeborenen Probanden mit einer Amblyopie innerhalb der letzten 12 Monate bei einer augenärztlichen Untersuchung gewesen sind im Vergleich zu 25,9 % bei Personen ohne Amblyopie.…”