Comparative study of visual functions in premature
               pre-school children with and without retinopathy of prematurity

Bonotto, Lígia Beatriz; Moreira, Ana Tereza Ramos; Chuffi, Silvia; Sckudlarek, Susana Maria Bittencourt

doi:10.5935/0004-2749.20140010

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Original Articles • Arq. Bras. Oftalmol. 77 (1) • Jan-Feb 2014 • https://doi.org/10.5935/0004-2749.20140010 copy

Comparative study of visual functions in premature pre-school children with and without retinopathy of prematurity

Estudo comparativo das funções visuais em pré-escolares nascidos prematuros com e sem retinopatia da prematuridade

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose:

Observe whether there are differences in visual functions among premature infants with treated retinopathy of prematurity (ROP) in relation to preterm infants with ROP and spontaneous regression; and among these two groups with ROP and the control group without ROP.

Methods:

Crosssectional observational no blind study. Premature infants were born between 06/199206/2006 and were exam between 06/200912/2010; registered in data of Hospital de Olhos Sandalla Amin Ghanem; with gestational age less than or equal to 32 weeks and 1,599 g born weigh; without ROP and ROP stages II or III, in one of the eyes, with spontaneous regression or with treatment; at least three visits during the selection period at maximum 6 months in the first exam and minimum 4 years of age in reassessment (chronological age) were include. Premature that did not respond or were not located for reassessment and those that did not have conditions to do the exams were exclude. Study's groups: G1 ROP posttreatment; G2ROP postspontaneous regression; G3 without ROP (control). Visual function evaluated with visual acuity (VA), contrast sensitivity test (CST), color test (CT), eye movement, stereopsis.

Results:

Overall, there were 24 premature infants and 48 eyes. Normal VA: 64.28% (G1), 87.5% (G2) and 100% (G3); Normal CST: 66.67% (G1), 100% (G2) and 55.56% (G3); Normal Ishihara CT: 100% (G1 and G2) and 86% (G3); Normal Farnsworth CT: 20% (G1), 75% (G2) and 50% (G3). Normal stereoacuity: 0.00% (G1); 25% (G2) and 3.5% (G3). Strabismus: 37% (G2), 0.00% (G1 and G3). The prevalent tendency for lower response in CST and CT between the premature children in group G3 and Farnsworth color test in G1 is a curious result of this work and more study is necessary about these visual functions in older premature children.

Conclusion:

The visual functions showed no statistically significant difference among the groups studied.

Infant, premature; Infant, premature, diseases; Retinopathy of prematurity; Visual acuity; Child, preschool

Motive of exclusion	Total number of premature children 432	% 100
Total number of premature children per study	24	6.0
Gestational weight and age above required	266	61.0
<3 visits during the selection period	39	9.0
Impossible to contact	22	5.0
Children aged <4 years on re-evaluation	11	2.5
Chronological age >6 months on first test	11	2.5
ROP stage higher or lower than required	11	2.5
Subnormal vision or severe neuropsychomotor impairment	9	2.0
Informed deaths	3	0.6
Children were followed up by another service	3	0.6
Other factors	33	7.6

Groups	N	Normal VA %	Low VA %	p value
G1 OD	7	71.43	28.57	0.569
G2 OD	8	87.50	12.50
G1 OS	7^* * = one premature child with amaurosis in the left eye after 6 years of age, secondary to total late retinal detachment. Normal= visual acuity considered as normal (20/30 or better).	57.14	42.84	0.282
G2 OS	8	87.50	12.50
G1 OD	7	71.43	28.57	0.175
G3 OD	9	100.00	0.00
G1 OS	7^* * = one premature child with amaurosis in the left eye after 6 years of age, secondary to total late retinal detachment. Normal= visual acuity considered as normal (20/30 or better).	57.14	42.84	0.282
G3 OS	9	100.00	0.00
G2 OD	8	87.50	12.50	0.471
G3 OD	9	100.00	0.00
G2 OS	8	87.50	12.50	0.471
G3 OS	9	100.00	0.00

Groups	N	NL TSC %	ALT TSC %	p value
G1 OD	6^* G1(*): one premature infant in G1 did not undergo the test on both eyes;	66.67	33.33	0.192
G2 OD	7^* G2 (*): one premature infant in G2 did not undergo the CST test.	100.00	0.00
G1 OS	5^ 1 (): another premature infant in G1 did not undergo the CST test on the left eye (total retinal detachment);	60.00	40.00	0.523
G2 OS	7^* G2 (*): one premature infant in G2 did not undergo the CST test.	85.71	14.29
G1 OD	6	66.67	33.33	1
G3 OD	9	55.56	44.44
G1 OS	5	60.00	40.00	1
G3 OS	9	55.56	44.44
G2 OD	7	100.00	0.00	0.088
G3 OD	9	55.56	44.44
G2 OS	7	85.71	14.29	0.308
G3 OS	9	55.56	44.44

Groups	N	CT IHNL %	CT IHALT %	p value
G1 OU	5	100.00	0.00	1
G3 OU	7	85.71	14.29
G2 OU	6	100.00	0.00	1
G3 OS	7	85.71	14.29

Groups	N	CT FW-D15 NL %	CT FW-D15 ALT %	p value
G1 OU	5	20.00	80.00	0.206
G2 OU	4	75.00	25.00
G1 OU	5	20.00	80.00	0.524
G3 OU	4	50.00	50.00
G2 OU	4	75.00	25.00	1
G3 OU	4	50.00	50.00

Groups	N	Strabismus Yes (%)	Strabismus No (%)	p value
G1 OU	7	0.00	100.00	0.200
G2 OU	8	37.50	62.50
G1 OU	7	0.00	100.00	-
G3 OU	9	0.00	100.00
G2 OU	8	37.50	62.50	0.082
G3 OU	9	0.00	100.00

Groups	N	Stereopsis NL (%)	Stereopsis ALT (%)	p value
G1 OU	7	0.00	100.00	p: 0.467
G2 OU	8	25.00	75.00
G1 OU	7	0.00	100.00	p: 0.200
G3 OU^* * = one premature infant did not undergo the Titmus test.	8	37.50	62.50
G2 OU	8	25.00	75.00	P:1
G3 OU	8	37.50	62.50

Groups		Gender		CRA (years)		GA (weeks)		WB (grams)		Number of Visits
	N	M (%)	F (%)	mean	DP	mean	DP	mean	DP	mean	DP
G 1	7	71	29	6.1	1.6	28.1	1.9	1.015	123.5	24.4	20.5
G 2	8	25	75	6.5	1.9	27.2	1.6	963.7	123.0	19.8	13.9
G 3	9	78	22	5.1	0.9	28.4	2.5	991.1	258.4	9.7	4.2

		Right eye				Left eye
		Spherical	Cylinder	Axis	Acuity	Spherical	Cylinder	Axis	Acuity
G1- laser
	1	+0.50	-0.50	180	20/20	0.00	-0.50	180	20/20
	2	+2.00	0.00	0	20/20	+1.50	0.00	0	20/30
	3	-5.50	-3.00	105	20/30	-4.25	0.00	0	20/25
	4	-4.25	-0.75	125	20/60	0.00	0.00	0	20/20
	5	+0.50	-1.75	180	20/30	-0.50	-3.00	180	20/40
	6	-6.50	-2.00	170	20/30	^* * = refraction impossible, total retinal detachment;			^ = amaurosis.
	7	-2.75	-0.50	180	20/63	-2.75	-0.50	180	20/63
G2- without laser
	8	+4.50	-1.25	10	20/20	+4.75	-1.50	170	20/20
	9	+2.25	0.00	0	20/20	+2.50	0.00	0	20/20
	10	+2.00	-0.50	165	20/20	+2.25	0.00	0	20/20
	11	+2.00	-0.50	180	20/20	+2.00	-0.50	165	20/20
	12	+0.25	-0.25	90	20/20	+0.25	0.00	0	20/20
	13	+1.50	-0.25	90	20/20	+1.50	-0.25	5	20/20
	14	+1.75	-1.25	15	20/50	+1.75	-1.50	180	20/50
	15	+2.00	-0.50	90	20/20	+1.50	0.00	0	20/20
G3- without ROP
	16	-0.25	0.00	0	20/20	0.00	0.00	0	20/20
	17	+2.50	0.00	0	20/20	+2.50	0.00	0	20/20
	18	+1.50	-0.75	180	20/20	+1.50	-1.00	180	20/20
	19	+1.00	-0.50	180	20/20	+1.00	-0.50	180	20/20
	20	+1.75	0.00	0	20/20	+2.00	-0.50	180	20/20
	21	+3.00	-0.25	90	20/20	+2.50	0.00	0	20/20
	22	+1.50	0.00	0	20/20	+1.50	-0.50	90	20/20
	23	+1.00	0.00	0	20/20	+1.00	0.00	0	20/20
	24	+1.25	-0.50	170	20/20	+1.50	0.00	0	20/20

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[1] Correspondence address: Lígia Beatriz Bonotto. Rua Abdon Batista, 146 - Joinville (SC) - 89201-010 - Brazil - E-mail: ligia@oftalmopediatria.com.br ou ligiaoftalmopediatria@sadalla.com.br