Development of refractive error in individual children with regressed retinopathy of prematurity

Abstract

Purpose: We investigated longitudinally the refraction development in children with regressed retinopathy of prematurity (ROP), including those with and those without a history of peripheral retinal laser photocoagulation.

Methods: Longitudinal (0-7 years) cycloplegic refraction data were collected prospectively for two groups of preterm children: severe ROP group included those with regressed ROP following bilateral panretinal laser photocoagulation (n = 37; median gestational age [GA] = 25.2; range, 22.7-27.9 weeks) and mild/no ROP group included those with spontaneously regressed ROP or no ROP (n = 27; median GA = 27.1; range, 23.1-32.0 weeks). Analyses were based on spherical equivalent (SEQ), anisometropia, astigmatism, and age (corrected for gestation).

Results: The prevalence, magnitude, and rate of myopic progression all were significantly higher in the severe ROP group than in the mild/no ROP group. Longitudinal SEQ in the severe ROP group were best fit with a bilinear model. Before 1.3 years old, the rate of myopic shift was -4.7 diopters (D)/y; after 1.3 years, the rate slowed to -0.15 D/y. Longitudinal SEQ in the mild/no ROP group was best fit with a linear model, with a rate of -0.004 D/y. Anisometropia in the severe ROP group increased approximately three times faster than in the mild/no ROP group. In the severe ROP group, with-the-rule astigmatism increased significantly with age.

Conclusions: The severe ROP group progressed rapidly toward myopia, particularly during the first 1.3 years; anisometropia and astigmatism also increased with age. The mild/no ROP group showed little change in refraction. Infants treated with laser photocoagulation for severe ROP should be monitored with periodic cycloplegic refractions and provided with early optical correction.

Keywords: laser photocoagulation; myopia; refractive error development; retinopathy of prematurity.

Figure 1

(A) SEQ for the right eye of each patient plotted against corrected age. The red dashed lines indicate individual patients in the severe ROP group (n = 37); the green dashed lines indicate individual patients in the mild/no ROP group (n = 27). The corresponding red and green bold lines show the best-fit models for the severe ROP group and for the mild/no ROP treated group. (B) The best fit models with the 95% CIs. The corresponding red and green bold lines show the best-fit models for the severe ROP group and for the mild/no ROP treated group. The fine dashed lines indicate the CI for the severe ROP group in red and for the mild/no ROP treated group in green.

Figure 2

(A) Magnitude of anisometropia for each patient plotted against corrected age. The red dashed lines indicate individual patients in the severe ROP group (n = 37); the green dashed lines indicate individual patients in the mild/no ROP group (n = 27). The corresponding red and green bold lines show the best-fit models for the severe ROP group and for the mild/no ROP treated group. (B) The best fit models with the 95% CIs. The corresponding red and green bold lines show the best-fit models for the severe ROP group and for the mild/no ROP treated group. The fine dashed lines indicate the CI for the severe ROP group in red and for the mild/no ROP treated group in green.

Figure 3.

J₀ for each patient plotted against corrected age. The red dashed lines indicate individual patients in the severe ROP group (n = 37); the green dashed lines indicate individual patients in the mild/no ROP group (n = 27). The corresponding red and green bold lines show the best-fit models for the severe ROP group and for the mild/no ROP treated group.

Figure 4.

The best-fit models of our study, along with fifth and 95^th percentiles CI derived from the models, presented with data from the literature.^,,–, Normal term-born control data from study of Mayer et al. is plotted in black circles with CI. If the results from the literature are from the group similar to the severe ROP group, they are plotted in red symbols and end in “1” in the legend. If the results from the literature are from the group similar to the mild/no ROP group, they are plotted in green symbols and end in “2” in the legend. If the literature separated the “mild ROP” in green-filled symbols and “no ROP” group in green open symbols, we used “2a” and “2b” to note in the legend, too. Data from the studies of Lue et al. and Holmstrom and Larsson were not plotted here, since it is difficult to extract the corresponding numbers from their figures.

Figure 5.

Four individuals who had laser treatment in one eye only (red symbols). For the two subjects shown on the left ([A] and [C]), the laser-treated eye is more myopic. For the two subjects shown on the right ([B] and [D]), the laser-treated eye is less myopic. All four patients became anisometropic.