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Extremely premature birth negatively influences visual outcomes in early adult life

15 Sep 2018

Young adults born extremely preterm (EP) exhibit considerable structural alterations at the fovea, a study has shown. Increased ganglion cell layer thickness is associated with poor best-corrected visual acuity (BVCA), with retinal layer thickness and BCVA being profoundly affected in eyes requiring neonatal treatment for retinopathy of prematurity (ROP).

Researchers followed 177 young adults (354 eyes; 226 from former EP infants and 128 from age-matched full-term controls) for 19 years to quantify inner and outer retinal layer thicknesses in relation to visual function.

In the EP group, 50 percent of eyes were not previously diagnosed with neonatal ROP, 38 percent had ROP not requiring treatment in the neonatal period, and 13 percent had neonatal cryotherapy or laser ablation for ROP.

Compared with control eyes, EP eyes showed significantly thicker inner and outer retinal layers and reduced BCVA. Retinal layer thicknesses and BCVA did not differ between eyes with untreated ROP and those without neonatal ROP. On the other hand, eyes with treated ROP had greater inner and outer retinal layer thickness and decreased vision.

Worse BCVA correlated with inner retinal layer thickness (p<0.001) but not outer retinal layer thickness (p=0.80). In multivariate linear regression models, ganglion cell layer thickness was a significant independent predictor of BCVA.

The present data provide insight into the pathophysiologic mechanisms after preterm birth that are involved in the maturation of the human fovea, researchers said.

Longitudinal studies are needed to examine changes in the retinal layers and visual acuity over time, as well as determine the postnatal age at which the increase in retinal ganglion layer thickness stops. This information would be important for future clinical trials using age-specific retinal thickness profiles as endpoints to predict visual acuity changes in ROP.

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