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Brittany M Wong, Du Tran-Viet, Shwetha Mangalesh, Sandra Holgado, Sandra S Stinnett, David K Wallace, Sharon F. Freedman, Cynthia A Toth, Lejla Vajzovic; Retinal microanatomy development on spectral domain optical coherence tomography and visual acuity in preterm infants. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4740.
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© ARVO (1962-2015); The Authors (2016-present)
Retinopathy of prematurity (ROP), even in milder forms, often correlates with vision loss (ArchOphthalmol. 2010; 128(6):663-71). We investigated preterm retinal development by handheld, bedside spectral domain optical coherence tomography (SDOCT) imaging and correlated with preterm birth, ROP, and visual acuity (VA).
Under a Duke IRB protocol, we enrolled and longitudinally imaged preterm infants undergoing ROP examination between 30 weeks (wks) post menstrual age (PMA) and 9 months (mos) corrected age, using a portable SDOCT system (Bioptigen, RTP, NC). We divided infants into 6 age groups: 30-32, 33-36, 37-42, 43-45, 51-53, and 75+ wks (approximately 9 mos) PMA. By age group, we analyzed for cystoid macular edema (CME), central foveal thickness (CFT), foveal-parafoveal (F-P) ratio, averaged ellipsoid zone (EZ) distance from the fovea, EZ presence and height at the fovea, and subfoveal choroidal thickness (SFCT). We evaluated VA with Teller acuity cards at 9 mos. Per normative data, normal VA was defined as ≥ 3.70 cycles per degree (Trans Am Ophthalmol Soc. 2014; 102: 235).
50 infants (mean gestational age (GA) 25.5 ± 2.1 wks, birthweight 801.6 ± 276.0 g) were enrolled and VA tested in 21 infants in this early analysis. CME first presented at 30-32 wks in 33% eyes, was most common at 37-42 wks in 71% of eyes, and persisted at 9 mos in 10% of eyes (Fig 1). Infants with CME had significantly greater CFT and F-P ratio at 33-36 wks PMA (p < 0.01, p = 0.01) and 37-42 wks PMA (p = 0.01, p = 0.04). EZ was first visible at the fovea at 33-36 wks in 6% of eyes, at 43-45 wks in 54% of eyes, and at 9 mos in 100% of eyes (Fig 2). Infants with CME at 37-42 wks PMA and infants with max ROP stage 3 vs stage 2 had lower VA (p = 0.04, 0.05). Mean VA did not differ significantly with the presence of EZ at the fovea, CME, or ROP treatment and did not correlate with GA, birthweight, CFT, EZ distance, or SFCT. For every 1 micron/4 week increase in EZ height development rate, the odds of normal VA increased by 7.5 (CI 0.94, 61; p = 0.058).
Abnormalities in the preterm retina including CME presence, higher maximum ROP stage, and lowered EZ height may be associated with lower VA at 9 mos. Findings indicate that retinal, particularly photoreceptor, development may correlate with VA outcomes. Further studies are warranted.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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