A prospective observational study found that thinning of the retinal nerve fiber layer in the papillomacular bundle was associated with poorer visual acuity of 9 months in premature infants.
A study published in Jama Ophthalmology found that premature babies had lower visual acuity (VA) when they had a layer of retinal nerve fiber (RNFL) that thinned through the papillomacular package (PMB), independently. of birth weight, gestational age, need for retinopathy of prematurity (ROP treatment) and macular microanatomy.
The study was part of the Study of Eye Imaging in Premature Babies (BabySTEPS). Babies were eligible for this study if they met the criteria for ROP screening, were 35 weeks postmenstrual age (PMA), or older at the time of the first optical coherence tomography (OCT) image, and a parent or guardian. gave written consent. Babies were excluded if they had an eye condition that prevented OCT imaging or retinal examination or a health condition that had an impact on brain development.
Babies were included in this subanalysis if they had OCT images of both eyes at weeks 38-42 or 35-37 PMA. If a baby had more than one imaging session at time intervals, the researchers selected the images closest to the 40- and 36-week PMA.
Sixty-one infants with a mean age (ED) of 27.6 (2.8) weeks and a birth weight of 958.2 (293.7) grams were included in the study. Babies enrolled between November 2016 and December 2019.
Monocular acuity of both eyes was successfully collected in 67 of the 118 babies enrolled in BabySTEPS. The acuity of the monocular lattice of both eyes was photographed with OCT in bed in 91% of infants with a mean of 39.85 (0.79) weeks PMA. Ninety-seven percent of infants were photographed with a mean of 36.03 (0.58) weeks PMA and were included in the secondary analysis.
There were 16 eyes of 8 infants who underwent ROP treatment before 40 weeks of PMA; 4 eyes of 2 infants also underwent treatment after 40 weeks PMA and were included in the post hoc analysis of the treatment cohort. Seventy-one (58%) eyes had subnormal grid VA at 9 months of age corrected: 34% had normal VA in both eyes, 51% had subnormal VA in both eyes, and 15% had normal VA in 1 eye. and subnormal in the other. The median (IQR) VA was 0.99 (95% CI, 0.81-1.10) logMAR.
Seventy-six (62%) eyes had macular edema in this study. Correlations were observed between retinal layer thicknesses and logMAR VA for internal retina (r, 0.19; 95% CI, 0.01-0.35), total retina (r, 0.15 95% CI, -0.02 to 0.31), choroid (r, -). 0.22; 95% CI, -0.38 to -0.03), RNFL throughout the PMB (r, -0.27; 95% CI, -0.45 to -0.10) and the inner nuclear layer ( r, 0.01; 95% CI, -0.07) to 0.27).
In univariate linear regression analysis, internal retinal thickness, total retinal thickness, choroidal thickness, and RNFL thickness across the PMB were associated with logMAR VA. ROP treatment before OCT imaging, gestational age, and birth weight was associated with logMAR VA in univariable regression analysis. The thickness of RNFL through PMB and ROP treatment before OCT imaging was associated with VA in the multivariable linear regression model.
There were some limitations in this study. The study was observational, which prevented researchers from inferring causal relationships between retinal microanatomy and AV outcomes, and relatively few eyes had ROP treatment, which prevented the underestimation of associations with laser ablation and injection of bevacizumab.
The researchers concluded that the research showed that thinning of the RNFL through short-term PMB was associated with a poorer VA at 9 months of corrected age that was independent of birth weight, gestational age. , the need for ROP treatment and macular microanatomy.
“Our findings suggest that thinning of the RNFL through PMB may be an early biomarker of global neurodevelopmental disruptions that put premature babies at risk for poorer vision outcomes,” the authors wrote.
Reference
Seely KR, Mangalesh S, Shen LL, et al. Association between retinal microanatomy in premature infants and 9-month visual acuity. JAMA Ophthalmol. Published online June 2, 2022. doi: 10.1001 / jamaophthalmol.2022.1643