Abstract
PURPOSE: This study aims to assess visual outcomes in children born preterm, stratified by gestational age, hypo- and hypertrophy, and the presence of retinopathy of prematurity (ROP) and its treatment. METHODS: This is a prospective observational cohort study (n = 949, 1889 eyes) assessing visual acuity, amblyopia, refractive error, and lens opacifications in a large sample of children born preterm and full-term aged 4-17 years. Covariates included gestational age, birth weight percentile, ROP status and treatment, maternal smoking, placental insufficiency, preeclampsia, breastfeeding, and perinatal adverse events with an adjustment for sex and age. Logistic regression analysis was conducted to evaluate associations. RESULTS: Amblyopia prevalence was mainly associated with a gestational age ≤ 28 weeks (OR = 2.92, p = 0.03), placental insufficiency (OR = 3.84, p = 0.01), and ROP treatment (OR = 15.71, p ≤ 0.001). Distant corrected visual acuity (DCVA) in the better eye was significantly correlated with gestational age (ρ = -0.083; p = 0.01), birth weight (ρ = -0.096; p = 0.004), birth weight percentile (ρ = -0.064; p = 0.05), ROP (ρ = 0.13; p <0.001), ROP treatment (ρ = 0.21; p <0.001), and perinatal adverse events (ρ = 0.135; p <0.001). The spherical equivalent was associated only with ROP treatment [β = -2.91, p < 0.001]. Lens opacifications were significantly larger in the group treated for ROP (p ≤ 0.01). CONCLUSIONS: This study highlights that perinatal factors associated with prematurity affect visual acuity and refractive error as well as the development of amblyopia in children. Mainly, extreme prematurity ≤28 weeks as well as ROP and its treatment are the most important factors affecting visual development.