Early treatment of ROP significantly improves grating visual acuity
MedWire News: Early treatment (ET) of high pre-threshold type 1, but not type 2, retinopathy of prematurity (ROP) significantly improves grating visual acuity in children at 6 years of age, suggest US study findings.
"Type 1 eyes should be treated early; however, based on acuity results at 6 years of age, type 2 eyes should be cautiously monitored for progression to type 1 ROP," say William Good (Smith-Kettlewell Eye Research Institute, San Francisco, California) and co-authors of the Early Treatment for Retinopathy of Prematurity Cooperative Group.
For the study, 317 infants with bilateral, high-risk (≥15% risk for blindness) pre-threshold ROP had one eye receive ET and the other eye treated only if ROP progressed to threshold severity (conventional management [CM]). A further 87 infants were classed as asymmetric cases and had the high-risk pre-threshold eye randomly assigned to receive ET or CM.
In total, 85.6% of children provided grating visual acuity data at 6 years of age using Teller acuity cards. No significant differences in unfavorable outcomes were seen between ET and CM, at 18.1% and 22.8%, respectively.
When the researchers classified grating acuity data according to type 1 and 2 categories, they found that type 1 high-risk pre-threshold eyes receiving ET had a significantly lower rate of unfavorable outcomes compared with type 1 eyes receiving CM (16.4% vs 25.2%, respectively).
However, no significant difference in the risk for unfavorable outcomes was seen between ET or CM treatment among children with type 2 eyes.
Distribution of grating acuity scores for eyes with high-risk pre-threshold ROP further confirmed the benefit of ET in type 1 eyes but not in type 2 eyes.
"Most type 2 eyes have ROP that regresses and does not require treatment. The results for grating acuity at 6 years of age support these earlier recommendations," say Good and team.
Further analysis showed that the greatest benefit of ET among children with bilateral high-risk pre-threshold ROP was seen in eyes classified as zone I, stage 3, with or without plus disease. The benefit of ET was seen for all risk categories, but was most pronounced in children with a 30% to 44% risk for unfavorable outcome.
Writing in the Archives of Ophthalmology, the researchers say the findings "support the ET of Diabetic Retinopathy Study acuity outcome results, making careful observation and identification of the International Classification of ROP characteristics even more important as one contemplates whether laser ablation should be performed."
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By Ingrid Grasmo