Visual outcomes and optical coherence tomography features in young adults born extremely preterm: The EPICure@19 Study

Abstract

Purpose : Preterm children have an increased risk of impaired vision from retinopathy of prematurity (ROP). Optical coherence tomography (OCT) studies have confirmed abnormal foveal development in preterm children. We investigated the relationship between chorioretinal morphological parameters and visual function in young adults born extremely preterm (EP).

Methods : In this prospective observational study, a total of 354 eyes (226 eyes of former EP infants born before 26 weeks and 128 age-matched full-term control eyes) from 177 young adults were evaluated at the age of 19 years. Subjects underwent eye examinations including best-corrected visual acuity (BCVA) and Heidelberg Spectralis OCT imaging. Macular retinal layers (Fig 1A) and the peripapillary retinal nerve fiber layer (RNFL; Fig 1B) were auto-segmented to compute thickness profiles. Choroidal area (CA), luminal area (LA), stromal area (SA) and choroidal vascularity index (CVI) were measured on a central horizontal B-scan (Fig 1C).

Results : Among the EP group, 50% were not diagnosed with ROP, 37% had ROP not treated previously and 13% had ROP treated previously with laser or cryotherapy. The inner retinal layer (IRL) and outer retinal layer (ORL) thickness were significantly (p<0.001) increased in EP compared with controls. IRL was positively correlated with logMAR BCVA but ORL was not. Multiple linear regression model analysis identified ganglion cell layer thickness as a significant predictor of logMAR BCVA (p < 0.001). Peripapillary RNFL thickness was significantly (p<0.0001) lower in EP compared with controls. LogMAR BCVA was negatively correlated to the nasal inferior sector (NI) of RNFL thickness and multivariable regression indicated that RNFT-NI thickness was a significant (p < 0.0001) predictor of logMAR.
The CA (p = 0.007), LA (p = 0.004) and SA (p = 0.03) were significantly decreased in the EP group compared with controls. There was no significant difference in CVI between groups. LogMAR BCVA was negatively related to choroidal LA and multivariable regression indicated that LA was a significant (p = 0.004) predictor of logMAR BCVA.

Conclusions : Following extremely preterm birth, at 19 years of age, the retina and choroid appear to be profoundly altered and associated with impaired vision. Further longitudinal studies are required to study the evolution of these retinal and choroidal changes over time.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.