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Retinopathy of prematurity screening: prevalence and risk factors of ophthalmic complications in non-treated preterm infants

Eye (2024)Cite this article

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Abstract

Introduction

Retinopathy of prematurity (ROP) is a vision-threatening disease of premature infants. Practice guidelines recommend that all infants screened for ROP receive follow-up eye examinations to screen for ophthalmic complications.1 The purpose of this study was to identify risk factors for the development of strabismus, amblyopia, high refractive error, and cataracts among ROP-screened, non-treated infants.

Methods

Retrospective single-centre study of ROP-screened, non-treated premature infants with ophthalmic follow-up. Clinical variables were screened for association with ocular findings at follow-up. Multivariable logistic regression was used to determine the risk factors associated with ocular findings.

Results

309 patients were seen for follow-up at 0.97 (0.69) [mean (SD)] years after neonatal intensive care unit (NICU) discharge. Strabismus was predicted by occipitofrontal circumference (OFC) z-score at NICU discharge (OR 0.61; 95% CI [0.42, 0.88]; p = 0.008), intraventricular haemorrhage (IVH) grade III or IV (OR 3.18; 95% CI [1.18, 8.54]; p = 0.02), and exclusive formula feeding at NICU discharge (OR 2.20; 95% CI [1.07, 4.53]; p = 0.03). Significant predictors of amblyopia were OFC z-score at discharge (OR 0.55; 95% CI [0.31, 0.96]; p = 0.03) and necrotising enterocolitis (NEC) (OR 6.94; 95% CI [1.38, 35.00]; p = 0.02). NEC was a significant risk factor for high refractive error (OR 7.27; 95% CI [1.39, 37.94]; p = 0.02).

Conclusions

Among premature infants screened but not treated for ROP, severe IVH, NEC, low OFC z-score, and exclusive formula feeding at NICU discharge were risk factors for ocular morbidity. These findings affirm the value of ophthalmic follow-up for all ROP-screened infants, particularly those with the identified risk factors.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank members of Department of Paediatrics and the Department of Ophthalmology and Visual Science for their collaboration on this project. Thank you to Gina Myers, RN, for her assistance in data collection and to Hongjie Gu for advice on statistical analysis.

Funding

This project was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR002344, the Doris Duke Charitable Foundation Fund to Retain Clinical Scientists under Grant 2020144, and an Unrestricted Grant from Research to Prevent Blindness. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Jacob I. Strelnikov, Rakesh Rao, Shahriyar Majidi, Gregg Lueder, Andrew Lee & Margaret M. Reynolds

  2. Saint Louis Children’s Hospital, 1 Children’s Place, St. Louis, MO, 63110, USA

    Margaret M. Reynolds

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  1. Jacob I. Strelnikov
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Contributions

JIS contributed to designing the study, conducting the chart review, extracting and analysing data, interpreting results, and writing the manuscript. RR contributed to designing the study, interpreting results, and writing the manuscript. SM contributed to designing the study, conducting the chart review, extracting and analysing data. GL contributed to designing the study and writing the manuscript. AL contributed to designing the study and writing the manuscript. MMR contributed to designing the study, extracting and analysing data, interpreting results, and writing the manuscript.

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Correspondence to Margaret M. Reynolds.

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Strelnikov, J.I., Rao, R., Majidi, S. et al. Retinopathy of prematurity screening: prevalence and risk factors of ophthalmic complications in non-treated preterm infants. Eye (2024). https://doi.org/10.1038/s41433-023-02921-1

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