Preemies Need a Lifetime of Vision Care

Worldwide, 15 million babies are born premature (less than 37 weeks gestational age) every year. This population is at greater risk of abnormal visual and neurological development than children born full term.  The more premature, the greater the risk.  Visual deficits associated with preterm birth include reduced visual acuity, higher rates of strabismus, high refractive errors, reduced stereo acuity (depth perception), loss of visual field, and reduced color vision.

Advanced neonatal care has resulted in the survival of more extremely premature babies (born before 27 weeks gestation).  Extreme preemies often develop retinopathy of prematurity (ROP), which can be severe and sight-threatening.  ROP develops because the retina is not fully developed at birth, even in full-term babies.  The transition to an aerobic environment at birth triggers major changes in retinal development which can be disastrous in the vastly underdeveloped retina of an extreme preemie.  Therefore, virtually every premature baby receives ophthalmological care during the first year of life to diagnose and treat ROP if warranted.

But what about their visual function as they grow up? A recent study looked at retinal function in 6 year old children born extremely premature, using electrophysiology recordings. These recordings evaluated how well their “rods and cones” were functioning. (Rods and cones are the retina’s photoreceptors that respond to light and initiate the electrical response that travels to the brain via the optic nerve.)

When compared to 6 year old children born at full-term, the extreme preemies were more likely to have a general dysfunction of the rods and cones.  It seems that the development of rods and cones was arrested by their extremely premature births, and persisted in childhood.

Deficits in vision extend beyond these basic measurements of visual acuity and electrophysiology.  All premature children (and not just those born extremely premature) are more likely to perform poorly on visual perceptual tasks such as those requiring visual-motor integration, visual discrimination, and spatial orientation.  As with other visual functions, the more premature, the greater the risk of visual perceptual deficits, and the more likely they are to persist into later childhood and even adulthood. BUT while every preemie is screened for ROP, very few receive comprehensive developmental vision assessments that are aimed at diagnosing deficits in these essential visual and visual perceptual skills. All of these visual skills, from visual acuity through visual perceptual skills, contribute to the well-being of the individual, as well as academic achievement, employment and social skills in childhood through adolescence and adulthood.

What does this mean for your prematurely born child?  It means that the risk for vision problems remains, whether or not diagnosed with ROP.  It means your child will require a lifetime of vision care, to optimize vision development. Schedule a comprehensive vision exam now, to be sure your child will have the best visual system  for a successful year, in school, and in life!

Baby D’s Story

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My daughter was unexpectedly born at 30 weeks weighing in at 1lb 12oz and 13 1/2 inches long.  We were told that she was the smallest baby born at that level 2 NICU at the time.   We prepared ourselves for the challenges of a premature baby by reading the material provided by the hospital on issues that could come up.   Fortunately our daughter encountered minimal issues.

A feeding tube was probably the biggest concern and she frequently pulled it out to show us how feisty she could be.  We became very good at swaddling to help keep her arms away from the tube.  We read about kangaroo care and we both took turns holding her this way.  It was an amazing bonding experience.  We participated in all aspects of her care in the NICU including changing her diaper and feeding her through the feeding tube.  She may have looked delicate at such a small size but we learned to handle her with care and not to be afraid.  She was sent home earlier than expected at 3lb 13oz since she was doing everything she needed to do. The hospital staff felt that she would be better off at home.  We read about Retinopathy of Prematurity (ROP) and she was screened several times but thankfully it was not an issue, but she did need slight vision correction as she got older.

As she has grown, she has never been a slave to fashion, so we lucked out there, so it came as a surprise when she picked out a very expensive pair of colorful Gucci frames.   How could we say no?  She puts them to good use as she is always reading.   I can’t tell you how many times she has read the Harry Potter series.   We were very fortunate after having such a premature baby, but maintaining a positive attitude helped us all get through it.

Molnar AE, Andreasson SO, Larrson EK, Akerblom HM, Holmstrom GE. Reduction of rod and cone function in 6.5 year-old children born extremely preterm. JAMA Ophthalmol 2017;135(8):854-861.
Leung MP, Thompson B, Black J, Dai S, Alsweiler JM. The effects of preterm birth on visual development. Clin Exp Optom 2017.

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