Do infants of birth weight less than 1500 g require additional long term ophthalmic follow up?

Abstract

Aim: To survey existing ophthalmic follow up protocols in the United Kingdom for very low birthweight (VLBW) children. In addition, relative risk analysis was performed using data from a cohort study to assess which factors (birth weight, gestational age, retinopathy of prematurity (ROP) status) led to a high risk of developing amblyogenic factors.

Methods: Questionnaires were sent to every orthoptic department in the United Kingdom (n = 288) for information on their policy on the follow up of VLBW children.

Results: Responses were received from 125 departments (43%). There was a large variation in criteria used for follow up; 21% of respondents using birth weight (BW) and gestational age (GA), 22% using stage 3 or treated ROP, the remainder using a combination of these factors. There was no consensus regarding when follow up should commence (from 3 months to 3 years) or cease (1–8 years). Relative risk analysis revealed that birth weight under 1500 g, GA under 33 weeks, and the presence of severe ROP were significant risk factors for developing one or more amblyogenic factors.

Conclusion: There is no consensus on whether VLBW children need to be reviewed. There is a greatly increased risk of ophthalmic deficits in those with severe ROP or severe neurological disorders, and also in those with mild or no ROP. Children in the latter group who are not routinely followed up, have a high risk of developing treatable refractive errors and strabismus. This raises the question of whether an additional screening examination is merited.