Progesssion of Myopia and Anisometropia in Individual Children with Regressed Retinopathy of Prematurity

Abstract

 

Purpose

 

The prevalence of myopia increases from 58% (6-MO-old) to 68% (9-MO-old) in children with severe retinopathy of prematurity (ROP) following peripheral retinal laser ablation (Quinn et al 2008). However, individual patterns of myopia progession are not well documented. Here we compare the long-term individual refractive error (particularly myopia and anisometropia) development of preterm children with or without a history of laser treatment.

 

Methods

 

Longitudinal (0-7 years) cycloplegic refraction data was obtained from medical records of preterm children with normal-appearing posterior poles. Group 1: regressed ROP following bilateral panretinal laser (n=38; gestational age (GA)=25.4±2.7 wk); Group 2: no or spontaneously regressed ROP (n=35; GA=26.8±3.0 wk). Children with eye or brain malformations, or cotical visual impairment were excluded. Analyses were based on right eye spherical equivalent (SEQ), anisometropia (SEQ difference), and age (corrected for gestation).

 

Results

 

Groups 1 and 2 showed a significant difference in development of refractive error (Fig 1). Group 1 SEQ was best fit with a bi-linear spline model: y1=0.09-4.47*Age when Age≤1.3 years; y2=-5.61-0.17*(Age-1.3) when Age>1.3 years. Before the age of 1.3 years, the rate of myopic shift was -4.5D/year; after 1.3 years, the rate slowed to -0.2D/year. Group 2 SEQ was best fit with a linear model: y=1.66+0.007*Age; i.e., there was little change in refraction with age. In Group 1, by 12 months of age, most children (73%) were myopic and 36% had high myopia (≤-5D). In Group 2, most had low hyperopia and 87% maintained hyperopia at the final visit. Anisometropia was significantly larger in Group 1 than in Group 2 (P=0.029) initally and increased about two times faster than in Group 2 (0.27 vs 0.12 D/year) (Fig 2).

 

Conclusions

 

Unlike preterm children who had no ROP or whose ROP underwent spontaneous regression, laser-treated children showed rapid progression of myopia during the first 1.3 years and increasing anisometropia during the first 7 years, Therefore, infants treated with panretinal photocoagulation for severe ROP can develop early and rapidly progressive myopia; they should be monitored closely with periodic cycloplegic refractions and early optical correction.

 

 

Best fit models based on individual SEQ against corrected age.

 

 

Best fit models based on individual anisometropia against corrected age.

 

Keywords: 706 retinopathy of prematurity • 677 refractive error development • 605 myopia