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Background/aims: This study represents an external validation with model updating of the online DIGIROP-Prescreen and DIGIROP-Screen 2.0 prediction models, incorporating ≥14 days of parenteral nutrition as an additional predictor, to identify infants requiring treatment for retinopathy of prematurity (ROP) in a contemporary Swedish cohort, estimate potential cost savings and compare DIGIROP performance with other models.

Methods: Infants born in Sweden, 2021-2023 (n=1530) were evaluated. ROP and neonatal data were retrieved from Swedish quality registers. Sensitivity, specificity and the area under the receiver operating characteristic (AUC) curve were calculated. In the V & auml;stra G & ouml;taland Region cohort (n=245), the DIGIROP models were compared with WINROP and two Postnatal Growth and ROP (G-ROP) models. We estimated DIGIROP models' cost-saving.

Results: The mean gestational age was 27.7 (SD 2.2) weeks, birth weight 1029 (SD 317) g, 689 (45.0%) were girls and 85 (5.6%) infants received ROP treatment. For DIGIROP-Prescreen 2.0, the AUC was 0.89 (95% CI 0.86 to 0.92), sensitivity was 100% (95% CI 95.8% to 100%) and specificity 27.5% (95% CI 25.3% to 29.9%). For DIGIROP-Screen 2.0, the cumulative specificity increased from 27.7% to 67.8% between postnatal weeks 6-14, with a sensitivity of 100%. In total, ∼Int$750 000 could have been saved in screening costs in Sweden during 2021-2023 using DIGIROP models. DIGIROP-Screen at postnatal age 10 weeks had the same sensitivity but higher specificity than G-ROP. WINROP showed lower sensitivity but the highest specificity.

Conclusion: DIGIROP 2.0 demonstrated high sensitivity and the most robust discrimination for treatment-requiring ROP in a contemporary Swedish cohort, compared with other models, with the potential to reduce unnecessary eye examinations and healthcare costs.

Aim

To explore longitudinal associations between ophthalmological outcome and development of visual perception, fine motor precision, and visual-motor integration (VMI) in children born very preterm (gestational age <32 weeks).

Method

This was a prospective longitudinal cohort study of 113 children (51 females, 62 males) born very preterm. Visual acuity, low-contrast visual acuity, stereopsis, and strabismus were investigated at 2 years 6 months (n = 98), 6 years 6 months (n = 84), and 12 years (n = 59). VMI was assessed at 6 years 6 months and 12 years, and visual perception and fine motor precision at 12 years, with the Beery-Buktenica Developmental Test of Visual-Motor Integration. Controls born at term were assessed at 6 years 6 months (n = 64) and 12 years (n = 46).

Results

For children born preterm, subnormal visual acuity at 2 years 6 months was related to both poorer VMI and fine motor precision at 12 years. Subnormal visual acuity, strabismus, and stereopsis at 6 years 6 months were also related to poorer VMI, visuo-perceptual, and fine motor measures at 12 years. These associations were not present in controls born at term.

Interpretation

Subnormal ophthalmological function at 2 years 6 months and 6 years 6 months in children born very preterm is related to poorer performance on VMI, visuo-perceptual, and fine motor precision tasks at 12 years, indicating that the quality of visual input interacts with developing visual-motor abilities. The results of this study provide new insights on the relationship between ophthalmological function and neurodevelopment after preterm birth.

Purpose

To estimate the effect of dexamethasone eye drops on the risk of progression from type 2 retinopathy of prematurity (ROP) to ROP requiring traditional treatments.

Design

Register-based cohort study.

Participants

Preterm infants born before 30 weeks’ gestation from 2015–2018 (control years) and from 2020–2021 (intervention years) registered in the Swedish Quality Register for ROP at 4 Swedish sites were included. In 1 of these sites, the intervention site, topical dexamethasone was introduced during the later period when type 2 ROP was diagnosed.

Methods

The frequency of traditional ROP treatments (laser ablation or intravitreal injection of anti–VEGF) was compared between the 2 periods at sites that had and had not introduced topical dexamethasone during the later period. Analyses were conducted both on infants with severe ROP and on all included infants. The difference-in-differences statistical method was used.

Main Outcome Measures

The proportion of infants that required traditional ROP treatment in each group and the interaction odds ratio, adjusted for potential confounding factors.

Results

At the intervention site, the incidence of traditional ROP treatment fell from 23/32 (72%) to 4/32 infants (13%; P < 0.001) with severe ROP and from 23/409 (5.6%) to 4/217 screened infants (1.8%; P = 0.03). For the 3 control sites, the equivalent numbers were from 82/175 (47%) to 32/57 infants (56%; P = 0.22) and from 82/950 (8.6%) to 32/441 infants (7.3%; P = 0.38). The difference-in-differences analyses resulted in an adjusted interaction odds ratio of 0.05 (95% confidence interval, 0.01–0.22; P < 0.001) for infants with severe ROP, suggesting a markedly larger decline in occurrence of traditional ROP treatments at the intervention site.

Conclusions

In this population of infants with severe ROP, the introduction of dexamethasone eye drops was associated with a significant reduction in the proportion of infants requiring traditional ROP treatments. A timely administration of low-dose dexamethasone eye drops may serve as a simple, cost-effective, and noninvasive intervention to reduce one of the leading causes of severe visual impairment worldwide. Further studies are needed to confirm our findings.

BACKGROUND: Retinopathy of prematurity (ROP) is an avoidable cause of childhood blindness. Effective ROP screening enables the detection of cases requiring treatment, but the frequency of ROP varies in units across South Africa (SA). Recent evidence suggests that a high proportion of infants in SA do not complete screening. A comparison of ROP prevalence and completeness of screening in units within the same region has yet to be described. METHODS: A prospective study of infants screened for ROP at five units was conducted between 1 February 2023 and 30 April 2024 in Cape Town, SA. Data were extracted for infants with birth weight <1250 grams or gestational age <32 weeks from the Retinopathy of Prematurity South African (ROPSA) register. RESULTS: Screening was initiated in 933 infants and completed in 468 (50.2%). Completeness of screening varied in the units from 36.8% to 74.6%. The prevalence of ROP among infants who started screening (16.1%-71.2%), completed screening (13.1%-64.3%), and those incompletely screened (25.0%-79.2%) also varied in the units. Among those diagnosed with ROP (n = 315), 179 (56.8%) had incomplete screening, including 30 (n = 51, 58.8%) infants with stage 3 ROP. CONCLUSION: Completeness of screening and ROP prevalence varied widely in the units. Of concern is the high proportion of infants with ROP, including stage 3 ROP, who do not complete screening. Measures to increase completeness of screening are needed to improve the detection of cases requiring treatment. The ROPSA register will allow these improvements to be monitored over time.

Purpose The Extremely Preterm Infants in Sweden Study (EXPRESS) followed a national cohort of extremely preterm born (EPT, i.e. <27 weeks) children until 12 years of age. This study aimed to investigate the longitudinal development of visual acuity (VA) in children born EPT, explore the predictive value of early visual assessments, and evaluate risk factors for visual impairment at the age of 12 years. Methods All 462 children born EPT in Sweden during April 2004-March 2007, and surviving to age 6.5 years, and full-term born matched controls were invited to participate in the 12-year follow-up. VA was assessed at 12 years and the results were compared with values at 2.5 and 6.5 years. Results At age 12, 332 (72%) EPT survivors and 189 controls were examined. The mean VA in the EPT group was lower than in the control group (1.15, 95%CI [1.12-1.19] vs. 1.33, 95% CI [1.29-1.37]). Fifteen (4.5%) EPT had visual impairment. The examination at age 2.5 failed to identify most of them, while the examination at 6.5 could predict the final visual outcome at 12. Risk factors for visual impairment were low gestational age, moderate and severe intraventricular haemorrhage, treatment-requiring retinopathy of prematurity, cerebral palsy, and cognitive disability. Conclusion In this national cohort, the VA outcome at age 12 was lower in children born EPT than full-term controls. As eye examination at 2.5 years did not reliably identify visual impairment, clinical risk factors should be considered in the screening of children born EPT to early identify the visually impaired.

Background/Aims: To determine whether retinopathy of prematurity (ROP) screening is initiated on time according to current South African (SA) guidelines, that is, before the onset of stage 3 and type 1 ROP.

Methods: A prospective study of preterm infants screened at five neonatal units between 1 May 2022 and 31 January 2023 in Cape Town, SA. Data on all infants screened with a birth weight <1250 g or gestational age (GA) <32 weeks were extracted from the ROP South African (ROPSA) register, including postnatal age (PNA) and postmenstrual age (PMA) at first screening.

Results: A total of 696 infants were included, 58.9% (n=410) of whom had an early ultrasound (EUS) for GA estimation. Overall, 220 (31.6%) infants developed ROP, 20 (2.9%) had stage 3 or type 1 and 7 (1.0%) required treatment. Screening was initiated on time according to SA criteria in 549 (78.9%) infants, none of whom had stage 3 or type 1 ROP at first screening. Stage 3 and type 1 ROP were first detected at PNA and PMA of 6.3 and 33.1 and 8.9 and 35.9 weeks, respectively. Most infants (319, 45.8%) were screened according to PNA only, and 78.9% of the 185 infants screened only once did not attend subsequent examinations.

Conclusion: Screening started on time in most infants and prior to the development of severe ROP. Due to the limited availability of EUS in our region and to promote complete screening, we recommend that screening be initiated using PNA alone at 4-6 weeks or prior to discharge, whichever is earliest. The low proportion of infants with stage 3 and type 1 ROP is a limitation in our study. Therefore, recommendations may not be generalisable to South African regions where neonatal care results in a higher proportion of infants developing type 1 ROP.

Objective Retinopathy of prematurity (ROP) registers enable population-based studies to monitor ROP screening programmes to improve their effectiveness. The aim of this study was to determine the frequency of ROP and the coverage of screening in a South African cohort using a prospective ROP South African (ROPSA) register.

Methods and analysis Infants born from 1 May 2022 to 31 January 2023 and screened prospectively for ROP at five neonatal intensive care units in Cape Town were included. The screening criteria were a gestational age (GA) <32 weeks or birth weight (BW) <1250 g. Data were extracted from the ROPSA register and analysed.

Results 696 of 1154 (60.3%) eligible infants were screened, almost half of whom (45.7%) did not complete screening. ROP was detected in 220 infants (31.6%, 95% CI 28.3% to 35.3%), 7 (1.0%) of whom required treatment. Infants with incomplete screening had a lower mean GA than those who completed screening; 28.7 (SD 1.6, range 25–33) and 29.1 (SD 1.7, range 24–36) weeks, respectively (p=0.004) and a lower mean BW; 1048 (SD 203, range 650–1690) g and 1108.5 (SD 227, range 640–1840) g, respectively (p<0.001).

Conclusions Data from the ROPSA register on the frequency of any ROP and treatment-requiring ROP may be biased due to low screening coverage and high incomplete screening. Reasons need to be explored and corrective interventions initiated. The ROPSA register will enable the impact of these interventions to be monitored. The findings of this study will contribute to the ongoing revision of South African national ROP screening guidelines.

AIM: Retinopathy of prematurity (ROP) risk factors have been investigated in population-based studies from most global regions. No such studies are available from Sub-Saharan Africa (SSA), where improved neonatal care is increasing the survival of preterm infants at risk of ROP.

METHODS: A population-based study was conducted in infants born in Cape Town, South Africa, from 1 May 2022 to 31 January 2023. The screening criteria were birth weight < 1250 g or gestational age < 32 weeks. The data were extracted from the Retinopathy of Prematurity South African register.

RESULTS: The study included 378 screened infants, 115 (30.4%) of whom developed ROP. In the multiple regression analyses, lower birth weight was an independent ROP risk factor, OR 1.3 95% CI 1.2-1.5, p < 0.001. Surgical necrotising enterocolitis (NEC) was the only other independent ROP risk factor, OR 5.8 95% CI 1.6-21.0, p = 0.007. Infants with birth weight < 1000 g were 39.4% (130/378) of those screened and more likely to develop ROP compared to larger infants, OR 2.4 95% CI 1.5-3.9, p < 0.001.

CONCLUSION: Birth weight remained a significant ROP risk factor, especially for those born weighing less than 1000 g. These infants represented a larger proportion of screened infants compared to previous Sub-Saharan African studies.

Purpose

Very preterm birth increases risk for neonatal white matter injury, but there is limited data on to what extent this persists into adolescence and how this relates to ophthalmological outcomes. The aim of this study was to assess brain MRI findings in 12-year-old children born very preterm compared to controls and their association with concurrent ophthalmological outcomes.

Methods

We included 47 children born very preterm and 22 full-term controls (gestational age <32 and >37 weeks, respectively). Brain MRI findings were studied in association with concurrent ophthalmological outcomes at 12-year follow-up.

Results

Evans index (0.27 vs 0.25, p<0.001) and a proposed “posterior ventricle index” (0.47 vs 0.45, p=0.018) were increased in children born very preterm. Higher gestational age associated with larger corpus callosum area (β=10.7, 95%CI 0.59–20.8). Focal white matter lesions were observed in 15 (32%) of very preterm children and in 1 (5%) of full-term controls. Increased posterior ventricle index increased risk for visual acuity ≤1.0 (OR=1.07×10¹¹, 95%CI=7.78–1.48×10²¹) and contrast sensitivity <0.5 (OR=2.6×10²⁷, 95%CI=1.9×10⁸–3.5×10⁴⁶). Decreased peritrigonal white matter thickness associated with impaired visual acuity (β=0.04, 95%CI 0.002–0.07).

Conclusion

More white matter lesions and evidence of lower white matter volume were found in children born very preterm compared with full-term controls at 12-year follow-up. The association between larger posterior ventricle index and reduced visual acuity and contrast sensitivity suggests disturbances of the posterior visual pathway due to diffuse white matter lesions.

Purpose: To investigate central retinal morphology and optic retinal nerve fibre layer (RNFL) in prematurely born young adults and compare to term born controls.

Materials and Methods: The participants were 59 prematurely born individuals, with a birthweight <= 1.500 g, and 44 term born controls, all 25-29 years of age. Visual acuity (VA) and contrast sensitivity (CS) were assessed. The retinal macular thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness and RNFL thickness were assessed with Cirrus optical coherence tomography (OCT).

Results: Central macular thickness was increased (mean 26.7 mu m) in prematurely born individuals compared to controls. The macular GC-IPL was thinner (mean 3.84 mu m), also when excluding those with previous retinopathy of prematurity (ROP) and those with neurological complications. Gestational age at birth and previous treatment of ROP were risk factors for a thicker macula, however, not for reduced GC-IPL. The average peripapillary RNFL was thinner (mean 4.61 mu m) in the prematurely born individuals, also when excluding those with previous ROP and/or neurological complications. Within the prematurely born group, treated ROP was correlated with increased average RNFL. Further, both better VA and CS were associated with thinner optic nerve RNFL and thicker average GC-IPL.

Conclusion: Macular and optic nerve morphology were influenced by premature birth as assessed with OCT in adult individuals. Gestational age at birth and treatment for ROP seemed to affect central macular thickness, and treated ROP affected the peripapillary RNFL. Thus, retinal sequelae remained in adulthood.