Cerebral damage risks vision in children born prematurely

By Sarah Guy

Cerebral damage and retinopathy of prematurity (ROP) are independently associated with the risk for visual impairment in 4-year-old children who were born prematurely, show Danish study results.

While ROP has already been established as the main cause of visual impairment in this subset of patients, the importance of cerebral damage has been unclear until now, remark the researchers.

They suggest their results should alert pediatricians and pediatric ophthalmologists to the possibility of cerebral damage in children born under 28 weeks' gestation.

"This will ensure that relevant measures are taken to refer children with cerebral damage to a multidisciplinary team specializing in the clinical evaluation and rehabilitation of children with cerebral visual impairment," write Carina Slidsborg (Glostrup Hospital) and colleagues in the Archives of Ophthalmology.

Their study compared visual acuity, foveal sequelae, maximum ROP stage, and presence of global developmental deficits (indicating cerebral damage) in 178 extremely preterm children and 56 postal code-matched term-born (37 to <42 weeks' gestation) children.

Better-eye fovea scores (FS; measured using fundus photographs), where a score of 0 equals normal and 4 equals retinal retinoschisis or detachment, and global developmental deficits (measured with the Ages and Stages Questionnaire), were more frequently abnormal among preterm- than term-born children, say Slidsborg and co-investigators.

Indeed, the team found after multiple comparisons correction that moderate-to-severe FS (a score of at least 2), compared with no FS, and presence of global developmental deficit were significantly independently associated with visual impairment.

Specifically, these variables resulted in respective odds ratios of 6.3 and 8.7 for a logMAR visual acuity of 0.3 or greater (Snellen scale 0.5 or less), indicating visual acuity loss.

Of those children with visual acuity loss, 33.3% who had foveal abnormalities also had cerebral damage, which raises concerns, say Slidsborg and team, that in the current clinical ophthalmologic setting, ROP sequelae are given "too much importance" when attributing the cause of visual impairment.

The researchers also confirmed ROP as a risk factor for visual impairment. They found significantly lower visual acuity among extremely preterm-born children receiving treatment for ROP compared with their term-born peers and those extremely preterm-born children without ROP, with a mean logarithmic acuity of 0.00-0.95, compared with 0.09 and 0.14, respectively.

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