Factors that influence refractive errors in premature infants

Main Article Content

Ni Made Ayu Surasmiati
Ariesanti Tri Handayani
I Wayan Eka Sutyawan

Abstract

Background
The prevalence of refractive errors is reported to be higher in children born preterm. Factors such as gestational age, birth weight, and retinopathy of prematurity status, have a significant impact on the refractive development in preterm infants. Prematurity and low birth weight affect the development of organ systems in infants, including the eyes. In addition to immature retinas, other eye conditions, such as refractive status, are also observed. This study aimed to determine the risk factors of refractive status, specifically refractive errors (spherical equivalent, astigmatism, and anisometropia) in premature infants at a tertiary hospital in Bali.


Methods
A cross-sectional study was conducted involving 53 premature infants. This study collected samples from January to August 2023 at the Neonatal Intensive Care Unit of Prof. dr. IGNG Ngoerah General Hospital. Data regarding gender, gestational age, birth weight, retinal condition, spherical equivalent, and refractive disorders were collected. The relationship between risk factors and spherical equivalent, astigmatism, and anisometropia were analyzed using multiple regression analysis with statistical significance set at p<0.05.


Results
Hypermetropia is the most common finding in premature infants, followed by myopia and astigmatism. The prevalence of myopia (9.4%) and astigmatism (5.7%) is also more common among newborns of gestational age ≤30 weeks (p=0.024). Chronological age was significantly associated with spherical equivalent (β=0.424; p=0.019).


Conclusion
In premature infants, chronological age was the risk factor of spherical equivalent. Other risk factors were not associated with the prevalence of refractive errors among premature infants.

Article Details

How to Cite
Surasmiati, N. M. A., Handayani, A. T. ., & Sutyawan, I. W. E. . (2024). Factors that influence refractive errors in premature infants. Universa Medicina, 43(1), 44–50. https://doi.org/10.18051/UnivMed.2024.v43.44-50
Section
Original Articles

References

Perin J, Mulick A, Yeung D, et al. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health 2022;6:106-15. https://doi.org/10.1016/S2352-4642(21) 00311-4.

Ohuma E, Moller AB, Bradley E, et al. National, regional, and worldwide estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. Lancet 2023;402:1261-71. doi: 10.1016/S0140-6736(23)00878-4.

Pamungkas S, Irwinda R, Wibowo N. High morbidity of preterm neonates in pregnancy with preeclampsia: a retrospective study in Indonesia. J South Asian Feder Obst Gynae 2022;14:157–60. doi: 10.5005/jp-journals-10006-2023.

Cutland CL, Lackritz EM, Mallett-Moore T, et al. Low birth weight: case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine 2017;35(48 Pt A):6492-500. doi: 10.1016/ j.vaccine.2017.01.049.

Zha Y, Zhu G, Zhuang J, Zheng H, Cai J, Feng W. Axial length and ocular development of premature infants without ROP. J Ophthalmol 2017;2017: 6823965. doi: 10.1155/2017/6823965.

Wang Y, Pi LH, Zhao RL, Zhu XH, Ke N. Refractive status and optical components of premature babies with or without retinopathy of prematurity at 7 years old. Transl Pediatr 2020;9: 108-16. doi: 10.21037/tp.2020.03.01.

Luu TM, Rehman-Mian MO, Nuyt AM. Long term impact of preterm birth neurodevelopmental and physical health outcome. Clin Perinatol 2017; 44:305-14. doi: 10.1016/j.clp.2017.01.003.

Burstein O, Zevin Z, Geva R. Preterm birth and the development of visual attention during the first 2 years of life: a systematic review and meta-analysis. JAMA Netw Open 2021;4:e213687. doi: 10.1001/jamanetworkopen.2021.3687.

Prakalapakorn SG, Greenberg L, Edwards EM, DEY Ehret. Trends in retinopathy of prematurity screening and treatment: 2008–2018. Pediatrics 2021;147:e2020039966. doi: 10.1542/peds.2020-039966.

Sabri K, Ells AL, Lee EY, Dutta S, Vinekar A. Retinopathy of prematurity: a global perspective and recent developments. Pediatrics 2022;150: e2021053924. doi: 10.1542/peds.2021-053924.

Semeraro F, Forbice E, Nascimbeni G, et al. Ocular refraction at birth and its development during the first year of life in a large cohort of babies in a single center in northern Italy. Front Pediatr 2020;7:539. doi: 10.3389/fped.2019. 00539.

Sukumaran KS, Thankamma J, Meleaveetil P, Syamala K. Is prematurity a risk factor for refractive errors in children? results from school vision screening program. J Evid Based Med Health 2020;7:2380-83. doi: 10.18410/jebmh/ 2020/493.

Fieß A, Schuster AKG, Nickels S, et al. Association of low birth weight with myopic refractive error and lower visual acuity in adulthood: results from the population-based Gutenberg Health Study (GHS). Br J Ophthalmol 2018;103:99-105. doi: 10.1136/bjophthalmol-2017-311774.

Akhtar N, Khalid A, Firduas U. Prevalence and profile of myopia of prematurity in a tertiary centre. Int J Cur Res Rev 2020;12:178-81. http://dx.doi.org/10.31782/IJCRR.2020.12224.

Mao J, Lao J, Liu C, et al. Factors that influence refractive changes in the first year of myopia development in premature infants. J Ophthalmol 2019;2019:7683749. doi: 10.1155/2019/7683749.

Hsieh CJ, Liu JW, Huang JS, Lin KC. Refractive outcome of premature infants with or without retinopathy of prematurity at 2 years of age: a prospective controlled cohort study. Kaohsiung J Med Sci 2012; 28:204–11. doi: 10.1016/j.kjms. 2011.10.010.

Katsan SV, Adakhovskaia AA. Axial length and refraction errors in premature infants with and without retinopathy of prematurity. J Ophthalmol (Ukraine) 2019; 487:39-43.

Birch EE, Kelly KR. Normal and abnormal visual development. In: Taylor DS, Hoyt C, editors. Pediatric ophthalmology and strabismus. 6th Ed. London: Elsevier; 2022. pp.32-40.

Ozdemir O, Tunay ZO, Acar E, Acar U. Refractive errors and refractive development in premature infants. J Fr Ophtalmo 2015; 38:934-40. doi: 10.1016/j.jfo.2015.07.006.

Solebo AL, Teoh L, Rahi J. Epidemiology of blindness in children. Arch Dis Child 2017;102:853-7. doi: 10.1136/archdischild-2016-310532.

Hong EH, Shin YU, Cho H. Retinopathy of prematurity: a review of epidemiology and current treatment strategies. Clin Exp Pediatr 2022;65: 115–26. https://doi.org/10.3345/cep.2021.00773.

Siswanto JE, Bos AF, Dijk PH, et al. Multicentre survey of retinopathy of prematurity in Indonesia. BMJ Paediatr Open 2021;5:e000761. doi: 10.1136/bmjpo-2020-000761.

Sitorus RS, Djatikusumo A, Andayani G, Barliana JD, Yulia DE. Pedoman nasional skrining dan terapi retinopathy of prematurity (ROP) pada bayi premature di Indonesia. Jakarta: Perdami FKUI IDAI; 2011. Indonesian.

Dervisogullari MS, Keskek NS, Pelit A. Effects of retinopathy of prematurity and its treatment on ocular alignment and refraction at 1 year old: preliminary reports. Ret Vit 2020;29:20-5. doi: 10.37845/ret.vit.2020.29.4.

Mohd-Ali B, Asmah A. Visual function of preterm children: a review from a primary eye care centre. J Optom 2011;4:103-9. https://doi.org/10.1016/S1888-4296(11)70049-8.

Ozdemir O, Ozen-Tunay Z, Erginturk-Acar D. Growth of biometric component and development of refractive errors in premature infants with or without retinopathy of prematurity. Turkish J Med Sci 2016;46:468-73. https://doi.org/10.3906/sag-1501-40.

Vincent SJ, Collins MJ, Read SA, Carney LG. Myopic anisometropia: ocular characteristics and aetiological considerations. Clin Exp Optom 2014;97:291-307. doi: 10.1111/cxo.12171.