First large population-based study investigating long-term risks supports need for ophthalmologic follow-up of children and adults born before eight months of gestation

People born prematurely are at a higher increased risk for a variety of eye-related complications throughout their life, but until now, the risk had not been measured. New research from Sweden shows that individuals born very and extremely premature may face up to a 19 times greater risk of retinal detachment than their peers.

Retinopathy of prematurity (ROP) is an eye disease that occurs in a small percentage of premature babies where abnormal blood vessels grow on the retina — the light-sensitive layer of cells lining the back of the eye that help us see. In some cases, the abnormal blood vessels may shrink and go away without treatment. In other cases, the vessels may continue to develop and serious eye and vision problems may occur, such as myopia, amblyopia, strabismus, glaucoma and detached retina.

The middle of the eye is filled with a clear gel called vitreous that is attached to the retina. A detached retina can occur when the vitreous fluid in the eye pulls hard enough to tear the retina in one or more places. Fluid may pass through a retinal tear, lifting the retina off the back of the eye  much as wallpaper can peel off a wall. When the retina is pulled away from the back of the eye like this, it is called a retinal detachment. The retina does not work when it is detached and vision becomes blurry. A retinal detachment is a very serious problem that almost always causes blindness unless it is treated with detached retina surgery.

The risk of retinal detachment in people born prematurely was studied by researchers examining nationwide population registries to find subjects born prematurely (less than 8.6 months) between 1973 and 2008. The subjects were then divided into two groups: those born between 1973 and 1986 at which point a national ROP screening program was established. The other group included those born between 1987 and 2008 and had received the ROP screening.

The researchers found that for people born extremely premature (approximately 6.5 months), the risk of retinal detachment was 19 times greater for those born before 1987, and nine times greater for those born after 1987. Subjects born very prematurely (6.5 to 7.2 months) had a four times greater risk of retinal detachment before the ROP screening program, and a three-fold risk once the screening program was put in place.

Currently, the American Academy of Pediatrics, the American Academy of Ophthalmology and other organizations recommend screening for ROP in infants born at less than 30 weeks of gestation or those with a birth weight of less than 1500 grams (or those with a birth weight of less than 2000 grams with an unstable clinical course). Based on the results of this research, individuals who have been treated for ROP as newborns should also continue follow up screenings with an ophthalmologist on a yearly basis.

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