OCULAR MORBIDITY IN PREMATURE CHILDREN

Mihir Kothari; V. Narendran; Parag K. Shah

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Mihir Kothari¹, V. Narendran², Parag K. Shah³.

¹Director, Jyotirmay Eye Clinic and Pediatric Low Vision Center, Thane W, Maharashtra, India,
²Chief Medical Officer and Head of the Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore 641 014, Tamilnadu, India,
³Consultant, Vitreo-retinal Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore 641 014, Tamilnadu, India.
Email: drmihirkothari@yahoo.com

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Other vision threatening ocular morbidity associated with Prematurity :

Myopia :

Low birth weight, prematurity and ROP all significantly impact the refractive state in the long term.27,28 At age 10-12 years children born preterm (even if there was no ROP) have an increased prevalence of all refractive errors.27 The prevalence of myopia in babies with Prethreshold ROP is 64.5%28 and does not change significantly with treatment. The severity and incidence of refractive error is inversely related to the gestational age and birth weight and directly related to the severity of the disease. Every premature child is recommended to have a routine eye evaluation between 4 - 6 months of age for the assessment of the refractive status of the eye and ocular alignment.

Squint :

The prevalence of strabismus in general population is 1 - 2% while at 9 months, 20 - 30% of infants with prethreshold ROP have strabismus.29 The presence of strabismus in child can be associated with 1) Lack of binocularity and stereo-acuity, 2) Amblyopia, 3) Reduced field of vision, 4) 50% increased chance of losing the good eye due to injury, 5) Reduced Self esteem. An early intervention as early as 4 months of age is usually recommended.

Amblyopia :

With an increased prevalence of squint and refractive errors a child who is prematurely born has a proportionately higher incidence of Amblyopia. It can affect one eye or both the eyes and can be treated if detected early. The treatment generally entails appropriate spectacle correction and/or occlusion therapy.

Cerebral Visual Impairment :

Pre-term newborns represent a high-risk population for brain damage, primarily affecting the white matter, and for related neurodevelopmental disabilities. 30 This can be associated with the damage to the anterior or the posterior visual pathways leading to severe to mild visual impairment. Nearly 19% Children have ophthalmic deficits while another 47% have both, neurological and ophthalmic deficits. 31 The associated ophthalmic deficits range from the strabismus in 37%, oculomotor apraxia or gaze palsy in 15%, nystagmus in 11%, optic atrophy in 17%, refractive errors in 9% and squint in 37%, These children need to have an early intervention by the vision stimulation, management of all other ocular comorbidities as mentioned above. A concurrent consultation with the occupational therapist, physiotherapist and pediatric neurologist is required in many.

Summary :

A pre-term child is at a high risk for developing various vision threatening ocular disorders that need an early referral to the ophthalmologist for the intervention.

Compliance with Ethical Standards

Funding None

Conflict of Interest None

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