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Findings From the Early Treatment for Retinopathy of Prematurity Study

Deborah K. VanderVeen, MD; David K. Coats, MD; Velma Dobson, PhD; Douglas Fredrick, MD; Robert A. Gordon, MD; Robert J. Hardy, PhD; Daniel E. Neely, MD; Earl A. Palmer, MD; Scott M. Steidl, MD; Betty Tung, MS; William V. Good, MD; for the Early Treatment for Retinopathy of Prematurity Cooperative Group

Arch Ophthalmol. 2006;124:766-773.

Objective  To present strabismus data for premature infants with prethreshold retinopathy of prematurity (ROP) enrolled in the Early Treatment for Retinopathy of Prematurity study.

Design  The prevalence of strabismus was tabulated for all of the infants with high-risk prethreshold disease who participated in the randomized trial of the Early Treatment for Retinopathy of Prematurity study and were examined at 6 and/or 9 months' corrected age as well as for all of the infants with low-risk prethreshold disease who were examined at 6 months' corrected age.

Main Outcome Measures  Presence or absence of strabismus at 6 and 9 months' corrected age.

Results  The prevalence of strabismus at 6 months was higher for infants with high-risk prethreshold ROP than for those with low-risk prethreshold ROP (20.3% vs 9.6%, respectively; P<.001). Risk factors associated with the development of strabismus at 9 months include abnormal fixation behavior, presence of amblyopia, and outborn birth status (ie, born outside of a study-affiliated hospital). At 9 months, 30% of infants with high-risk prethreshold ROP had strabismus, although only 42% showed strabismus at 6 months. Thirty percent of infants with strabismus at 6 months showed normal alignment at 9 months.

Conclusions  Infants with high-risk prethreshold ROP show significant variability in the presence vs absence of strabismus in the first year of life; thus, conservative management is recommended.

Application to Clinical Practice  Ophthalmologists managing strabismus in infants who have high-risk prethreshold ROP should be aware of the significant variability in ocular alignment during the first year of life.

Author Affiliations: Children's Hospital Boston, Harvard Medical School, Boston, Mass (Dr VanderVeen); Texas Children's Hospital, Baylor College of Medicine (Dr Coats) and School of Public Health, University of Texas Health Science Center (Dr Hardy and Ms Tung), Houston; Department of Ophthalmology and Vision Science, University of Arizona, Tucson (Dr Dobson); Department of Ophthalmology, University of California (Dr Fredrick) and Smith-Kettlewell Eye Research Institute (Dr Good), San Francisco; Department of Ophthalmology, Tulane University Medical Center, New Orleans, La (Dr Gordon); Department of Ophthalmology, Indiana University, Indianapolis (Dr Neely); Casey Eye Institute, Oregon Health & Science University, Portland (Dr Palmer); and Department of Ophthalmology, University of Maryland School of Medicine, Baltimore (Dr Steidl).

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