Retinal structure correlated with visual acuity in ROP

This study found that posterior pole appearance generally correlates very well with recognition visual acuity in 6-year-old children with a history of advanced retinopathy of prematurity (ROP).

However, when outcomes are discordant, the authors say it is usually due to unfavorable visual outcomes and favorable retinal structural outcomes, as there are many factors beyond retinal structure that can reduce visual acuity test results in these children. These include optic atrophy and cortical visual impairment.

The authors assessed the relationship between retinal structure and visual acuity at six years in 606 high-risk prethreshold ROP eyes randomized to early treatment or conventional management in the Early Treatment for Retinopathy of Prematurity study.

Concordant outcomes occurred in 462 eyes (76.2 percent): 402 eyes had favorable functional and structural outcomes and 60 eyes had unfavorable functional and structural outcomes. Most eyes (87 percent) with normal retinal structure had visual acuity better than 20/200, although fewer than half (40.7 percent) had visual acuity of 20/40 or better. Discordant outcomes occurred in 92 eyes (15.2 percent): 86 eyes had unfavorable functional and favorable structural outcomes and 6 eyes had favorable functional and unfavorable structural outcomes.

Of the 86 eyes with unfavorable functional and favorable structural outcomes, 43 had optic atrophy and/or retinal abnormalities that were less severe than those considered to be unfavorable.

Some eyes had no recognizable ocular abnormality to account for subnormal visual acuity. The authors say that in some of these cases, there may have been cortical visual impairment, while in others, there may also be subtle macular abnormalities associated with severe ROP not detected by standard indirect ophthalmoscopy.