Premature birth linked to increased retinal detachment risk later in life

This large population-based study shows that babies born more than two months early face a substantially increased risk of retinal detachment not just in childhood, but through adulthood.

Including more than 3 million babies born in Sweden who were followed for a median of 17 years, this is the largest, long-term study evaluating the association between preterm birth and the risk of retinal detachment. Compared with babies born at term, those born extremely prematurely (<28 weeks) from 1973 through 2008 had a 19 times higher risk of retinal detachment. Among babies born between 1987 and 2008, the risk was nine times higher after adjustment for potential confounders, including maternal smoking.

Babies born very prematurely (28 to 31 weeks) from 1973 through 2008 had a 4-fold increased risk, while those born between 1987 and 2008 faced a nearly three-fold increased risk. They found no increased risk among babes born moderately preterm, 32 to 36 weeks. The authors say the decreased risk over the two time periods studied is suggestive of Sweden’s improved ROP screening program and improved ROP treatment.

How many of us ask whether a patient was preterm? It appears that this is a significant risk factor that cataract surgeons should be asking about during their routine work-up. However, it is challenging to apply this information clinically because many adults who were born prematurely don't know what their gestational age was, and most who know they were preemies were not born more than two months early and therefore are not at risk. 

Even though most children and adults born prematurely did not experience retinal detachment, the authors conclude that there is a need for long-term follow-up of subjects born very and extremely prematurely with a history of severe and treated ROP for early detection and treatment of late-onset retinal detachment. As the risk of retinal detachment increases with age and there has been a dramatic increase in survival of subjects born prematurely since the 1970s, the authors say it is possible that so far we are observing only the tip of the iceberg of late ophthalmic complications after preterm birth.