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Retinoscopy may help predict course of astigmatism, anisometropia in children with ROP

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Performing retinoscopy exams in children with retinopathy of prematurity at 2.5 years of age may help to predict their need for astigmatism and anisometropia correction when they reach school age, researchers in Sweden said.

Eva K. Larsson, MD, PhD, and Gerd E. Holström, MD, PhD, of Uppsala University Hospital evaluated the development of astigmatism and anisometropia over time in 198 children with ROP. All children underwent cycloplegic retinoscopy exams at 6 months, 2.5 years and 10 years of age.

The researchers found that the prevalence of astigmatism of 1 D or more fell significantly between 6 months and 2.5 years (P < .001). Between 2.5 and 10 years of age, the prevalence of astigmatism was unchanged regardless of the stage of ROP.

Multiple regression analysis showed that severe ROP treated with cryotherapy and the presence of 1 D or more of astigmatism at 2.5 years of age were the only independent risk factors associated with astigmatism at age 10 years, according to the study. Children with astigmatism of 2 D or more were 40 times more likely to have astigmatism at 10 years of age, the authors noted.

"The differences in the development of astigmatism between [preterm and full-term] children may be caused by an arrest in the normal process of emmetropization, ie, disturbances in ocular growth such as changes in axial length, an increase in corneal curvature, a shallower anterior chamber and a thicker lens, which have been described in preterm children," the study authors said.

Anisometropia averaged 0 D between 6 months and 2.5 years and subsequently increased to 0.25 D (P < .001). Despite the increase in amount, the prevalence of anisometropia remained stable throughout the study, suggesting "the process of emmetropization had already been disturbed early in life," the authors said.

Anisometropia of 2 D or more at 2.5 years was the only independent risk factor for having anisometropia at 10 years (P < .001), they said.

The authors recommended that all preterm children undergo follow-up examinations at 2.5 years, as amblyopia seems preventable at this age and eyeglasses can improve the development of vision.

The study is published in the November issue of Archives of Ophthalmology.