Association of Birth Weight With Foveolar Thickness in Adulthood: Results From a Population-Based Study

Sex-Specific Differences in the Relationship Between Prematurity and Ocular Geometry

Purpose

To explore differences in the relationship between gestational age (GA) and birth weight (BW) percentile and ocular geometry between males and females.

Methods

The Gutenberg Prematurity Eye Study involved a prospective ophthalmic examination of adults, aged 18 to 52 years, who were born preterm or at term, in Germany. The associations between GA and BW percentile on the main outcome measures were evaluated by uni- and multivariable linear regression analyses. The main outcome measures were central corneal thickness, corneal radius, anterior chamber depth, lens thickness, posterior segment length, and central foveal thickness. Potential sex-specific differences and an effect modification by sex were analyzed.

Results

This study involved 438 participants (245 females, 193 males) with an average age of 28.6 ± 8.7 years. In female participants, central foveal thickness was negatively associated with a higher GA (B = -2.99; P < 0.001). Similarly, male participants also demonstrated a negative association between central foveal thickness and GA (B = -4.27; P < 0.001). The multivariable model with effect modification revealed that the central foveal thickness was thicker with lower GA. There was an association between the effect modification of GA with sex and central foveal thickness, demonstrating a more pronounced effect of GA on central foveal thickness in male participants (B = 1.29; P = 0.04).

Conclusions

This study identified a sex-specific correlation between lower GA and thicker central foveal thickness, suggesting differences in the developmental trajectory of this biometric parameter concerning GA. A thicker central foveal thickness might affect the visual acuity of individuals born preterm in adulthood, with a more pronounced impact in males and a potential predisposition to age-related diseases later in life. Sex did not influence the association of GA or BW percentile to other ocular geometric parameters.

[Ophthalmological long-term sequelae of premature birth-Persisting into adulthood : Eye development and premature birth anamnesis]

BACKGROUND

Premature birth and the postnatal occurrence of retinopathy of prematurity (ROP) are the main risk factors for reduced visual acuity and blindness in childhood and adolescence accompanied by numerous morphological ocular changes.

OBJECTIVE

It can be assumed that these alterations persist throughout life and could represent a potential risk factor for ocular diseases, although little is known to date about the long-term effects of prematurity on ocular function and morphology in adulthood.

METHODS

The aim of the present study is to review the literature on the long-term effects of prematurity and associated factors.

RESULTS

Individuals born preterm exhibit reduced visual acuity, lower visual quality of life, and steeper corneal configuration in adulthood. Furthermore, individuals with advanced ROP and need for ROP treatment are at particularly high risk for myopic refractive error, the occurrence of strabismus, and increased lens opacities with thicker lenses. Low gestational age is associated with thinner peripapillary retinal nerve fiber layer thickness as well as thicker foveal retinal thickness and more frequent occurrence of foveal hypoplasia. In addition, data from the Gutenberg Health Study showed that low birth weight as a surrogate marker for prematurity and fetal growth restriction are associated with an increased prevalence of age-related macular degeneration as well as more frequently with diabetes and consequently diabetic retinopathy.

DISCUSSION

Premature birth and associated factors lead to life-long functional and morphological ocular changes. There is evidence that this can lead to retinal diseases later in life and thus, there appear to be fetal origins for adult eye disease. This may have implications for ophthalmic controls and its intervals in adulthood.

[Ophthalmic care of adults born preterm and full-term-results from the Gutenberg Prematurity Eye Study (GPES) : Premature birth and ophthalmological care]

BACKGROUND

Prematurity and the presence of retinopathy of prematurity (ROP) increase the risk for the occurrence of amblyogenic risk factors in childhood and adolescence.

AIM

The aim of the present study was to evaluate ocular morbidities and the ophthalmological care of former preterm and full-term persons in adulthood.

MATERIAL AND METHODS

The Gutenberg prematurity eye study (GPES) is a retrospective cohort study with a prospective ophthalmological examination of individuals formerly born preterm and full term between 1969 and 2002 (now aged 18-52 years). All participants underwent a detailed ophthalmological examination and were asked about the frequency of ophthalmological care. Participants were grouped into those with normal gestational age (GA) ≥ 37 weeks (control group), preterm individuals without ROP and GA 33-36 weeks (group 2), GA 29-32 weeks (group 3), GA ≤ 28 weeks (group 4), and those with ROP without treatment (group 5) and with ROP with treatment (group 6). All participants were asked if they had an ophthalmological examination within the last 12 months.

RESULTS

In total, data from 140 term and 310 preterm adults were included in the present study. Strabismus was present in 2.1 % (3/140), 6.6 % (9/137), 17.4 % (16/92), 11.1 % (2/18), 27.1 % (13/48) and 60 % (9/15) in groups 1-6, respectively. The proportion of subjects with an ophthalmological examination within the last 12 months was highest in the groups of extremely preterm persons with and without ROP compared with the control group. Overall, 33.3 % (1/3) of the term and 57.1 % (28/49) of the preterm subjects with strabismus and 0 % (0/3) of the term and 46.9 % (15/32) of the preterm individuals with amblyopia had an ophthalmological examination within the past 12 months.

DISCUSSION

Extremely preterm adults with and without postnatal ROP showed the highest rate of eye diseases as well as the highest rate of ophthalmological check-ups within the last 12 months. This suggests that extremely preterm adults particularly with the occurrence of postnatal ROP perceive more frequent ophthalmological check-ups throughout their lives.

Peripapillary Retinal Nerve Fiber Layer Thickness in Adults Born Extremely, Very, and Moderately Preterm With and Without Retinopathy of Prematurity: Results From the Gutenberg Prematurity Eye Study (GPES)

PURPOSE

This study investigated whether prematurity and associated factors or prenatal growth restriction have long-term effects on the peripapillary retinal nerve fiber layer (pRNFL) in adulthood.

DESIGN

Retrospective cohort study.

METHODS

The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination in Germany. Selected individuals born term and preterm (age 18-52 years) were examined with spectral-domain optical coherence tomography (SD-OCT) in adulthood, and perinatal medical charts were reviewed. The pRNFL thickness was measured using SD-OCT. Univariate and multivariable linear regression analyses were conducted to investigate associations between pRNFL and gestational age (GA; categorical), birth weight percentile (categorical), retinopathy of prematurity (ROP) occurrence, and treatment and other perinatal parameters with adjustment for age, sex, and spherical equivalent.

RESULTS

In total, 766 eyes of 406 preterm and full-term individuals were included (mean age 28.4 ± 8.6 years, 228 females). After adjustment for age, sex, and spherical equivalent, global pRNFL thinning was associated with moderate (GA = 33-36 wk, β = -4.68, P < .001), very (GA = 29-32 wk, β = -5.72, P < .001), and extreme (GA ≤ 28 wk, β = -8.69, P < .001) prematurity but not with low birth weight percentile (<25th percentile, P = .9) and ROP occurrence (P = .9) in multivariable analysis. ROP treatment was associated with increased pRNFL in the temporal sector (P = .002). Maternal smoking during pregnancy showed an association with pRNFL thinning (P = .07).

CONCLUSION

Our data indicate that the more preterm individuals are born the more pRNFL thinning occurs, whereas prenatal growth restriction and postnatal occurrence of ROP show less effects on pRNFL thickness. Furthermore, individuals with severe ROP with treatment but not lower ROP stages without treatment showed an increased temporal pRNFL thickness.

Augenärztliche Versorgung früh- und reifgeborener Personen in deren Kindheit und Jugend – eine retrospektive Sicht der Eltern

Hintergrund Das Ziel der vorliegenden Studie war die Beschreibung der augenärztlichen Versorgung in der Kindheit und Jugend früh- und reifgeborener Personen aus der retrospektiven Sicht der Eltern.

Patienten, Material und Methoden Die Gutenberg Prematurity Eye Study (GPES) ist eine retrospektive Kohortenstudie mit einer prospektiven augenärztlichen Untersuchung von früh- und reifgeborenen Personen, die zwischen 1969 und 2002 geboren wurden (aktuelles Alter 18 bis 52 Jahre). Sie schließt eine Befragung von deren Eltern zur augenärztlichen Versorgung ihrer Kinder in der Kindheit und Jugend aus der Retrospektive ein. Die Teilnehmenden und deren Eltern wurden in Personen mit normalem Gestationsalter (GA) ≥ 37 (Kontrollgruppe), Frühgeborene ohne ROP (Retinopathy of Prematurity) mit GA 33 – 36 (Gruppe 2), GA 29 – 32 (Gruppe 3), GA ≤ 28 Wochen (Gruppe 4) und solche mit ROP ohne Behandlung (Gruppe 5) und mit ROP mit Behandlung (Gruppe 6) gruppiert. Die Eltern der Teilnehmenden wurden zur augenärztlichen Versorgung und zur Zufriedenheit damit befragt.

Ergebnisse Insgesamt wurden die Daten von 57 reifgeborenen und 131 frühgeborenen Kindern und deren Eltern in die vorliegende Studie eingeschlossen. Die Eltern der Teilnehmenden gaben an, dass eine augenärztliche Untersuchung bis zum 6. Lebensjahr in den jeweiligen Gruppen 1 bis 6 bei 22/57 (38,6%), 33/58 (56,9%), 22/38 (57,9%), 3/6 (50%), 19/21 (90,5%) und 7/8 (87,5%) stattgefunden habe. Insgesamt gaben 83 – 100% der Eltern in den verschiedenen Gruppen an, dass die augenärztliche Betreuung gut gewesen sei. Einen Augenarztwechsel aufgrund von Behandlungsunzufriedenheit berichteten insgesamt 4/57 (7%), 9/58 (15,5%), 8/38 (21,1%), 1/6 (16,7%), 1/21 (4,8%) und 2/8 (25%) in den jeweiligen Gruppen.

Schlussfolgerung Die vorliegende Studie zeigt eine gute Behandlungszufriedenheit hinsichtlich der augenärztlichen Betreuung von ehemaligen frühgeborenen Personen, insbesondere Eltern von Kindern mit einer ROP bewerteten diese positiv.

RETINAL THICKNESS AND FOVEAL HYPOPLASIA IN ADULTS BORN PRETERM WITH AND WITHOUT RETINOPATHY OF PREMATURITY: The Gutenberg Prematurity Eye Study

PURPOSE

This study analyses whether prematurity, retinopathy of prematurity (ROP), and associated factors lead to altered foveal shape in adulthood and whether these alterations are associated with visual acuity.

METHODS

The Gutenberg Prematurity Eye Study is a German cohort study with a prospective ophthalmologic examination (participants aged 18-52 years) of individuals born preterm and full-term that were examined with spectral domain optical coherence tomography. Participants were grouped according to gestational age (GA) and postnatal ROP status. Multivariable linear regression analyses for foveolar retinal thickness, foveal hypoplasia, and posterior vitreous status were performed.

RESULTS

A total of 755 eyes of 414 preterm and full-term individuals were included (aged 28.6 ± 8.6 years, 233 female individuals). Central foveal retinal thickness increased as GA decreased. The prevalence of foveal hypoplasia was 2% (control group), 9% (GA 33-36), 18% (GA 29-32), 48% (GA ≤28), 50% (ROP without treatment), and 82% of eyes (with ROP requiring treatment). In multivariable analyses, central foveal thickness was independently associated with GA and advanced stages of ROP requiring treatment while foveal hypoplasia was only associated with GA. Posterior vitreous was more frequently visible as partially detached in full-term than in preterm individuals. Lower distant-corrected visual acuity correlated with increased foveolar thickness (rho = 0.08; P = 0.03) and with foveal hypoplasia (rho = 0.15, P < 0.001).

CONCLUSION

Our findings indicate that there are fetal origins affecting foveal shape, resulting in foveal hypoplasia potentially affecting the visual acuity in adulthood.

The role of preterm birth, retinopathy of prematurity and perinatal factors on corneal aberrations in adulthood: Results from the Gutenberg prematurity eye study

INTRODUCTION

Prematurity and retinopathy of prematurity (ROP) are associated with altered corneal shape and reduced visual acuity in childhood, but their long-term effects on corneal shape in later life are still unclear. This study evaluated whether prematurity and related perinatal factors are associated with corneal aberrations in adulthood.

METHODS

The Gutenberg Prematurity Eye Study (GPES) is a cohort study using Scheimpflug imaging of the cornea. Associations were assessed between corneal Zernike aberrations and gestational age (GA), birth weight (BW), BW percentile, ROP occurrence, ROP treatment and other perinatal factors using univariate and multivariable linear regression analyses.

RESULTS

This study involved 444 eyes of 256 individuals born preterm (aged 28.1 ± 8.4 years, 146 females) and 231 eyes of 132 individuals born full-term (aged 29.8 ± 8.9 years, 77 females). Multivariable analyses revealed an association between corneal higher-order aberrations and lower birth weight percentile (B = -0.001, p < 0.001) as well as ROP treatment (B = 0.120, p = 0.03). Corneal lower-order aberrations were also associated with lower birth weight percentile (B = -0.004; p = 0.001) and ROP treatment (B = 0.838, p = 0.01) but not with ROP occurrence. Increased corneal aberrations were correlated with lower visual acuity and the spherical equivalent refractive error.

CONCLUSIONS

Perinatal factors, particularly low birth weight percentile and ROP treatment lead to a more irregular corneal shape in adulthood, thereby reducing optical image quality and potentially contributing to reduced visual acuity and altered refractive error.

Foveal and Peripapillary Choroidal Thickness in Adults Born Extremely, Very, and Moderately Preterm With and Without ROP-Results From the Gutenberg Prematurity Eye Study

Purpose

The present study investigated the long-lasting effect of prematurity, prenatal growth restriction, and associated factors on foveal and peripapillary choroidal thickness in adulthood.

Methods

The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination in Germany. Foveal and peripapillary choroidal thicknesses were measured at different sectors using spectral-domain optical coherence tomography. Multivariable linear regression analyses were performed to determine associations among gestational age, birth weight percentile, retinopathy of prematurity (ROP) occurrence and treatment, and other perinatal factors, such as maternal smoking and others with foveal and global peripapillary choroidal thickness.

Results

A total of 735 eyes of 408 study participants were included (age = 28.4 ± 8.6 years, 229 women). Multivariable regression analyses revealed that foveal choroidal thinning was associated with maternal smoking during pregnancy (B = −38.1, 95% confidence interval [CI] = −65.5 to −10.7, P = 0.006), whereas other perinatal factors revealed no association. Global peripapillary choroidal thinning showed a trend to a lower birth weight percentile (B = 0.22, 95% CI = −0.01 to 0.45, P = 0.057). No correlation was observed between foveal and peripapillary choroidal thicknesses with visual acuity.

Conclusions

This study indicates that maternal cigarette smoking during pregnancy has adverse long-lasting effects on choroidal development in the fovea and low birth weight percentile as a surrogate marker for adverse perinatal growth might be linked with peripapillary choroidal thinning whereas prematurity showed no long-term effects.

Translational Relevance

Altered choroidal layer development caused by perinatal influence factors might be a risk factor for reduced visual function and predispose affected individuals to eye diseases in later life.

Dry Eye Parameters and Lid Geometry in Adults Born Extremely, Very, and Moderately Preterm with and without ROP: Results from the Gutenberg Prematurity Eye Study

Background/Aims: This study aimed to analyze the effects of perinatal history on tear film properties and lid geometry in adults born preterm. Methods: The Gutenberg Prematurity Eye Study (GPES) is a German prospective examination of adults born preterm and term aged 18 to 52 years with Keratograph® 5M and Schirmer test I. Main outcome measures were first non-invasive tear film break-up time (F-NITBUT), bulbar redness (BR), Schirmer test, and nasal palpebral angle measurement. The associations with gestational age (GA), birth weight (BW), and BW percentile, retinopathy of prematurity (ROP), ROP treatment, and other perinatal factors were evaluated using regression analyses. Results: 489 eyes of 255 preterm and 277 eyes of 139 full-term individuals (aged 28.6 +/− 8.8 years, 220 females) were included. Of these, 33 participants (56 eyes) had a history of spontaneously regressed ROP and 9 participants (16 eyes) had a history of ROP treatment. After adjustment for age and sex, lower F-NITBUT (<20 s) was associated with ROP treatment (OR = 4.42; p = 0.025). Lower GA correlated with increased bulbar redness (B = −0.02; p = 0.011) and increased length of wetting in the Schirmer test (B = −0.69; p = 0.003). Furthermore, low GA was associated with narrowing of the nasal palpebral angle (B = 0.22; p = 0.011) adjusted for age and sex, but not when considering ROP in the multivariable model. Conclusion: Our analyses indicate that perinatal history affects ocular surface properties, tear production and lid geometry in adults born term and preterm. This might indicate that affected persons have a predisposition to diseases of the corneal surface such as the dry eye disease.

Long-term visual outcomes of children screened for retinopathy of prematurity with telemedicine in New Zealand

CLINICAL RELEVANCE

Children with a history of regressed retinopathy of prematurity (ROP) are at increased risk of peripheral avascular retina. Wide-field digital retinal imaging and telemedicine is an effective tool for ROP screening. Ophthalmologists and Optometrists should have a high level of clinical suspicion for peripheral retinal changes in children screened for ROP.

BACKGROUND

Retinopathy of prematurity, a vaso-proliferative disorder of the pre-term retina, is a preventable cause of childhood visual impairment. The Auckland Regional Telemedicine ROP (ART-ROP) network, established in 2006, utilises wide-field digital imaging and telemedicine to screen at-risk infants for ROP. This prospective observational study reports the long-term ocular outcomes of ART-ROP network infants.

METHODS

A comprehensive paediatric eye examination including cycloplegic autorefraction and wide-field retinal imaging was completed on all participants. Participants had been screened for ROP by the ART-ROP network between May 2008 and October 2011.

RESULTS

A total of 69 children, with a mean age of 5 to 8 years old were assessed and divided into two groups: those with or without a history of ROP, 44 and 25 children, respectively. Infants with a history of ROP had significantly lower gestational age (26.6 ± 1.9 vs. 29.1 ± 1.6 weeks, p < 0.001) and birth weight (937 ± 237 vs. 1177 ± 311 grams, p = 0.001). No significant differences were detected between the two groups for visual acuity (p = 0.596), stereopsis (p = 0.219), refractive error (p = 0.472), or strabismus. Clinically significant refractive error was noted in 10 participants; none with moderate or high myopia. Retinal imaging exposed asymptomatic, persistent, peripheral avascular retina in four children, all of whom had a history of regressed ROP.

CONCLUSION

Visual and ocular outcomes did not vary based on history of ROP, with no participant having reduced vision as a result of undetected or untreated ROP. Further research is required into the long-term implication of persistent avascular retina in regressed ROP.