Progression of Myopia and High Myopia in the Early Treatment for Retinopathy of Prematurity Study: Findings to 3 Years of Age
Received 19 March 2007; received in revised form 23 July 2007; accepted 24 July 2007. published online 17 April 2008.
Purpose
Examine the prevalence of myopia and high myopia, at 6 and 9 months postterm and 2 and 3 years postnatal in preterm children with birth weights < 1251 g who developed high-risk prethreshold retinopathy of prematurity (ROP) in the neonatal period and participated in the Early Treatment for ROP Study.
Design
Randomized controlled clinical trial.
Participants
Four hundred one infants who developed prethreshold ROP and were determined to have a significant risk (≥15%) of poor structural outcomes without treatment. Children underwent cycloplegic retinoscopy at examinations between 6 months postterm and 3 years' postnatal age.
Intervention
Eyes were randomized to receive treatment at high-risk prethreshold ROP (early treated [ET]) or conventional management (CM), with treatment only if threshold ROP developed.
Main Outcome Measures
Myopia (spherical equivalent ≥ 0.25 diopters [D]) or high myopia (≥5.00 D) at each visit.
Results
Prevalences of myopia were similar in treated eyes in the ET and CM groups, increasing from approximately 58% to 68% between 6 and 9 months, with little change thereafter. Both ET and CM eyes showed an increasing prevalence of high myopia, approximately 19% at 6 months and increasing 4% to 8% at successive examinations. Zone of ROP and presence or absence of plus disease had little effect on prevalence of myopia or high myopia between ages 6 months and 3 years. However, eyes with ROP residua (straightened temporal vessels or macular heterotopia) showed a higher prevalence of myopia and high myopia than eyes without residua.
Conclusions
Approximately 70% of high-risk prethreshold ROP eyes were myopic in early childhood, and the proportion with high myopia increased steadily between ages 6 months and 3 years. Timing of treatment of high-risk prethreshold ROP did not influence refractive error development. There was little difference in prevalence of myopia or high myopia between eyes with zone I and eyes with zone II ROP, nor between eyes with plus disease and eyes with no plus disease. However, prevalence of myopia and high myopia was higher in eyes with retinal residua of ROP than in eyes with normal-appearing posterior poles, highlighting the importance of follow-up eye examinations of infants who had prethreshold ROP.
Available online: April 17, 2008.
1Division of Pediatric Ophthalmology, Children's Hospital of Philadelphia and Scheie Eye Institute, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
2Departments of Ophthalmology and Psychology, University of Arizona, Tucson, Arizona.
3Departments of Ophthalmology and Pediatrics, Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St. Louis, Missouri.
4University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas.
5Smith-Kettlewell Eye Research Institute, San Francisco, California.
Correspondence to Graham E. Quinn, MD, MSCE, Pediatric Ophthalmology, 1st Floor, Wood Building, Children's Hospital of Philadelphia, Philadelphia, PA 19104.
Manuscript no. 2007-368.
Supported by the National Eye Institute, Bethesda, Maryland (cooperative agreement nos. 5U10 EY12471, 5U10 EY12472).
The authors have no relevant financial interest in the article, with the exception of Dr Dobson, who has received royalties from the sale of Teller acuity cards.
⁎ A list of the Group members can be found in Early Treatment for Retinopathy of Prematurity Cooperative Group.28
ABSTRACT