Retinal Structure in Preterm Infants Can Foretell Visual Acuity at 9 Months

A pediatric practice in Lausanne, Switzerland
A pediatric practice in Lausanne, Switzerland. Eye examination. (Photo by: BSIP/Universal Images Group via Getty Images)
OCT exams of these patients may help identify those at risk for poor visual outcomes.

Infants born preterm who had thinning of the retinal nerve fiber layer (RNFL) across the papillomacular bundle (PMB) are likely to have poor visual acuity (VA) at 9 months, compared with thicker RNFL, according to findings published in JAMA Ophthalmology. This phenomenon was noted even in the absence of severe retinopathy of prematurity (ROP) the study shows.

The findings relied on the Study of Eye Imaging in Preterm Infants (BabySTEPS), a prospective observational study conducted at Duke University between 2016 and 2019. The research took into account 122 eyes of 61 infants who were screened by optical coherence tomography (OCT) at 35 weeks’ postmenstrual age. OCT features were correlated with VA at 9 months of age.

The study population was born at an average gestational age of 27.6±2.8 weeks, weighed 958.2±293.7 g, OCT was performed at 39.9±0.8 weeks’ postmenstrual age, and 13% received ROP treatment prior to OCT.

At 9 months, 58% had subnormal VA with a median VA of 0.99 (IQR 0.81-1.10) logMAR. In addition, 16% of eyes had strabismus, 3% nystagmus, and 2% amblyopia. The mean cycloplegic refraction was +0.34±1.96 D.

Stratified by normal and subnormal VA, no OCT retinal findings differed significantly.

VA at 9 months correlated with OCT RNFL across the PMB (r, -0.27) and choroid (r, -0.22).

In the final model, VA at 9 months was associated with ROP treatment prior to imaging (β, 0.33; 95% CI, 0.11-0.56; P =.003) and RNFL thickness across the PMB per 10 μm increase (β, -0.05; 95% CI, -0.10 to -0.01; P =.046).

In a post hoc analysis which included 4 additional eyes that underwent ROP treatment after 40 weeks’ postmenstrual age, the independent predictors remained significant.

The major limitation of this study was not evaluating causal relationships between retinal microanatomy and VA outcomes. Additional study is needed.

This study found that RNFL thinning across the PMB at 35 weeks’ postmenstrual age was an independent predictor for poorer VA outcomes at nine months.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Seely KR, Mangalesh S, Shen LL, et al. Association between retinal microanatomy in preterm infants and 9-month visual acuity. JAMA Ophthalmol. 2022;e221643. doi:10.1001/jamaophthalmol.2022.1643