Cerebral damage key factor for impaired vision

Retinopathy of prematurity (ROP) is widely considered the primary cause of visual impairment in extremely premature children. Now Danish researchers report that cerebral damage may be the strongest risk factor.

Researchers evaluated the relative importance of ROP and cerebral damage as risk factors for visual impairment in a clinical follow-up study of a national cohort of Danish children born before 28 weeks’ gestation. The 178 premature children enrolled in the study and 56 matched controls were assessed using a standardized measure of 5 developmental areas when they were 4 years old.

Almost 12% of the premature children displayed global developmental deficits compared with 4% of controls. There also was a trend toward an increasing rate of visual impairment with the severity of ROP. Stepwise regression analysis showed that both global developmental deficit and advanced retinal disease (moderate to severe foveal sequelae or a history of ROP treatment) were independent risk factors for visual acuity loss in extremely premature children, but cerebral damage appeared to be the primary risk factor.

These findings raise concerns that ROP sequelae are given too much importance, whereas cerebral damage is given too little. The researchers conclude that pediatric ophthalmologists and pediatricians should consider cerebral damage in all premature infants, even in cases in which blindness or visual impairment may be explained by ROP sequelae, and refer those with cerebral damage to multidisciplinary teams.

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