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Refractive Status in Nepalese Pre-Term and Full-Term Infants Early in Life

Uprety, Samir, OD1*; Morjaria, Priya, BScOptom, MSc2; Shrestha, Jyoti, B., MD3; Shrestha, Gauri, S., MOptom3; Khanal, Safal, OD, FAAO4*†

doi: 10.1097/OPX.0000000000001118

SIGNIFICANCE This study suggests that pre-term infants, even without retinopathy of prematurity, are at risk for abnormal refractive development and informs the need for close monitoring of refractive error in such infants, regardless of their retinopathy of prematurity status.

PURPOSE The present study aims to investigate the refractive error trend in Nepalese pre-term infants without retinopathy of prematurity (ROP) in the first 6 months of life and explore the association of refractive error with birth weight (BW) and gestational age (GA).

METHODS Thirty-six pre-term infants without ROP and 40 full-term infants underwent cycloplegic retinoscopy at birth, term (for pre-term only), 3 months, and 6 months chronologically. Refractive status was classified into emmetropia (mean spherical equivalent refraction [SER] 0 to +3.00D), myopia (SER < 0.00D), and significant hyperopia (SER > +3.00D). Refractive parameters at various age points were compared between the pre-term and full-term infants using general linear model repeated measures ANOVA.

RESULTS At birth, the SER in the pre-term infants was +0.84 ± 1.72D; however, there was a shift toward myopia at 6 months of age (SER = −0.33 ± 1.95D). There was a significant difference in SER, astigmatism, and anisometropia between pre-term and full-term infants by 6 months of age (P < .01). Astigmatism and anisometropia showed an increasing trend with age in pre-term infants (P < .05 at 6 months) in contrast to a decreasing trend in full-term infants (P < 0.05 at 3 and 6 months). In pre-term infants, there was a statistically significant positive relationship between GA and SER (β = 0.32, R2 = 17.6%, P < .05) but a negative relationship between BW and astigmatism (β = −1.25, R2 = 20.6%, P < .01).

CONCLUSIONS Pre-term infants who do not develop ROP show a trend toward increasing myopia and demonstrate greater astigmatism and anisometropia than full-term infants in their first 6 months of life.

1College of Optometry, Southwestern University, Cebu City, Philippines

2Faculty of Infectious Tropical Diseases, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom

3BP Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Kathmandu, Nepal

4School of Optometry and Vision Science, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand

*Contributed equally to this work

Submitted: January 21, 2016

Accepted: May 28, 2017

Funding/Support: None of the authors have reported funding/support.

Conflict of Interest Disclosure: None of the authors have reported a conflict of interest.

Author Contributions and Acknowledgments: Conceptualization: SU, PM, SK; Investigation: SU, GSS, JBS; Methodology: SU, GSS, SK; Formal Analysis; SU, SK; Project Administration: JBS, GSS; Resources: JBS, GSS; Software: SK, PM; Supervision: GSS, JBS, SK; Visualization: PM; Writing – Original Draft: SU, SK; Writing – Review & Editing: PM, SK.

The authors thank Myra Leung and Mitchell Nye-Wood from the University of Auckland for commenting on an early draft of this article.

© 2017 American Academy of Optometry