Astigmatism in the Early Treatment for Retinopathy of Prematurity Study: Findings to 3 Years of Age
Received 8 July 2008; received in revised form 20 August 2008; accepted 23 September 2008. published online 16 December 2008.
Purpose
To examine the prevalence of astigmatism (≥1.00 diopter [D]) and high astigmatism (≥2.00 D) at 6 and 9 months corrected age and 2 and 3 years postnatal age, in preterm children with birth weight of less than 1251 g in whom high-risk prethreshold retinopathy of prematurity (ROP) developed and who participated in the Early Treatment for Retinopathy of Prematurity (ETROP) Study.
Design
Randomized, controlled clinical trial.
Participants
Four hundred one infants in whom prethreshold ROP developed in one or both eyes and who were randomized after they were determined to have a high risk (≥15%) of poor structural outcome without treatment using the Risk Management of Retinopathy of Prematurity (RM-ROP2) program. Refractive error was measured by cycloplegic retinoscopy. Eyes with additional retinal, glaucoma, or cataract surgery were excluded.
Intervention
Eyes were randomized to receive laser photocoagulation at high-risk prethreshold ROP (early treated [ET]) or to be conventionally managed (CM), receiving treatment only if threshold ROP developed.
Main Outcome Measures
Astigmatism and high astigmatism at each visit. Astigmatism was classified as with-the-rule (WTR; 75°–105°), against-the-rule (ATR; 0°–15° and 165°–180°), or oblique (OBL; 16°–74° and 106°–164°).
Results
The prevalence of astigmatism in ET and CM eyes was similar at each test age. For both groups, there was an increase in prevalence of astigmatism from approximately 32% at 6 months to approximately 42% by 3 years, mostly occurring between 6 and 9 months. Among eyes that could be refracted, astigmatism was not influenced by zone of acute-phase ROP, presence of plus disease, or retinal residua of ROP. Eyes with astigmatism and high astigmatism most often had WTR astigmatism.
Conclusions
By age 3 years, nearly 43% of eyes treated at high-risk prethreshold ROP developed astigmatism of ≥1.00 D and nearly 20% had astigmatism of ≥2.00 D. Presence of astigmatism was not influenced by timing of treatment of acute-phase ROP or by characteristics of acute-phase or cicatricial ROP. These findings reinforce the need for follow-up eye examinations in infants with high-risk prethreshold ROP.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: December 16, 2008.
1Departments of Ophthalmology and Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, Missouri
2Departments of Ophthalmology and Vision Science and Psychology, University of Arizona, Tucson, Arizona
3Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia and Scheie Eye Institute, University of Pennsylvania Health System, Philadelphia, Pennsylvania
4University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas
5Smith-Kettlewell Eye Research Institute, San Francisco, California
6A list of the members of the Early Treatment for Retinopathy of Prematurity Cooperative Group can be found in Arch Ophthalmol 2003;121:1684–96
Correspondence: Bradley V. Davitt, MD, Cardinal Glennon Children's Medical Center, 1465 South Grand Boulevard, Saint Louis, MO 63104
Manuscript no. 2008-821.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by the National Eye Institute, National Institutes of Health, Bethesda, Maryland (cooperative agreement nos.: 5U10EY12471 and 5U10EY12472).
ABSTRACT