Extreme Prematurity Linked With Lifelong Visual, Ocular Deficiencies

Girl doing eye test.
Cape Town, South Africa,young girl having medical attendance at the optometrist
The visual and ocular deficits appear partially independent of retinopathy of prematurity, the investigators report.

Extreme prematurity (EP) is related to an increased prevalence of visual/ocular issues in young adults, according to the results of a prospective cohort study published in JAMA Network Open.

UK researchers assessed visual function and ocular disease in 256 eyes representing 128 participants (53% female participants; average age: 19.3 years), as well as 130 age-matched eyes representing 65 participants (62% female participants).

Volunteers received eye examinations as part of a comprehensive evaluation, with testing for best-corrected visual acuity, refractive status, contrast sensitivity, color vision, prevalence of strabismus/nystagmus, and patient-reported visual function

The mean best-corrected visual acuity was worse in the EP vs the control group (P <.001), according to the study. Strabismus was more prevalent in the EP group (36% vs 0%; P <.001), as well as abnormal ocular motility (15% vs 0%; P <.001), and nystagmus (13% vs 0%; P <.001).

The investigators observed no differences between the EP group and controls with respect to refractive error, contrast sensitivity, color vision, or patient-reported visual function. In total, 48% of eyes in the EP group exhibited no retinopathy of prematurity (ROP), 39% had ROP not requiring neonatal treatment, and 13% were administered cryotherapy or laser ablation for ROP. Volunteers in the ROP group exhibited no significant differences in binocular visual function parameters, prevalence of ocular morbidity, or patient-reported visual function by neonatal ROP status.

Limitations of the current study include attrition of participants. This study lasted 20 years, which made follow-up difficult. Overall, data come from less than half the initial cohort. The authors state that EP participants exhibited decreased rates of cognitive impairment at 19 years compared with that at 11 years of age. The estimates of overall visual impairment could have been an underestimate, considering that visual impairment is related to neurocognitive development issues.

“Extreme prematurity is associated with an increased prevalence of visual and ocular deficits in young adulthood,” the investigators report. “This study suggests that, for individuals born EP, visual and ocular deficits appear to be partially independent of ROP status in the neonatal period but reports similar overall visual function.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Jain S, Sim PY, Beckmann J, et al. Functional ophthalmic factors associated with extreme prematurity in young adults. JAMA Netw Open. Published online on January 4, 2022. doi:10.1001/jamanetworkopen.2021.45702