Functional Ophthalmic Factors Associated With Extreme Prematurity in Young Adults
Authors: Saurabh Jain, Peng Yong Sim, Joanne Beckmann, Yanyan Ni, Nabil Uddin, Bronia Unwin, Neil Marlow
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Children born preterm (&lt;37 weeks’ gestation) have a higher risk of visual impairment and ocular morbidities compared peers born at full term. However, the long-term ocular sequelae in adulthood for those born extremely preterm (EP), who have the highest risk of neonatal retinopathy, are unknown. <h3>Objective</h3> To evaluate visual function and ocular morbidity in young adults born EP compared with controls born full term. <h3>Design, Setting, and Participants</h3> This prospective cohort study of a geographically based birth cohort in the UK and Ireland born from March 1 through December 31, 1995, included 128 participants aged 19 years (born at 22-25 weeks’ gestation) and 65 age-matched controls born at full term. Statistical analysis was performed from March 1, 2020, to November 26, 2021. <h3>Exposures</h3> Participants underwent eye examinations as part of a comprehensive outcome evaluation. <h3>Main Outcomes and Measures</h3> Best-corrected visual acuity, refractive status, contrast sensitivity, color vision, prevalence of strabismus and nystagmus, and patient-reported visual function, measured using the Health Utilities Index Mark 3. <h3>Results</h3> The study comprised 128 participants (256 eyes; 68 female participants [53%]; mean [SD] age, 19.3 [0.5] years) and 65 age-matched controls born at full term (130 eyes; 40 female participants [62%]; mean [SD] age, 19.2 [0.5] years). Compared with control eyes, the mean (SD) best-corrected visual acuity among eyes in the EP group was significantly worse (monocular vision: −0.06 [0.14] logMAR in the control group vs 0.14 [0.38] logMAR in the EP group;<i>P</i> &lt; .001; binocular vision: −0.14 [0.15] logMAR in the control group vs 0.06 [0.37] logMAR in the EP group;<i>P</i> &lt; .001). Participants in the EP group had a significantly higher prevalence of strabismus (36% [46 of 127] vs 0%;<i>P</i> &lt; .001), abnormal ocular motility (15% [19 of 125] vs 0%;<i>P</i> &lt; .001), and nystagmus (13% [16 of 127] vs 0%;<i>P</i> &lt; .001) than the control group. No significant differences between participants in the EP group and controls were observed for refractive error, contrast sensitivity, color vision, or patient-reported visual function. Among the participants in the EP group, 48% of eyes (120 of 250) had no retinopathy of prematurity (ROP), 39% (98 of 250) had ROP not requiring neonatal treatment, and 13% (32 of 250) received cryotherapy or laser ablation for ROP. Within the EP group, there was no significant difference in binocular visual function parameters, prevalence of ocular morbidity, and patient-reported visual function by neonatal ROP status. <h3>Conclusions and Relevance</h3> Extreme prematurity is associated with an increased prevalence of visual and ocular deficits in young adulthood; this study suggests that, for individuals born EP, visual and ocular deficits appear to be partially independent of ROP status in the neonatal period but reports similar overall visual function.