Progression of myopia and high myopia in the early treatment for retinopathy of prematurity study: findings to 3 years of age

PURPOSE: Examine the prevalence of myopia and high myopia, at 6 and 9 months postterm and 2 and 3 years postnatal in preterm children with birth weights 1251 g who developed high-risk prethreshold retinopathy of prematurity (ROP) in the neonatal period and participated in the Early Treatment for ROP Study.

DESIGN: Randomized controlled clinical trial.

PARTICIPANTS: Four hundred one infants who developed prethreshold ROP and were determined to have a significant risk (>/=15%) of poor structural outcomes without treatment. Children underwent cycloplegic retinoscopy at examinations between 6 months postterm and 3 years' postnatal age.

INTERVENTION: Eyes were randomized to receive treatment at high-risk prethreshold ROP (early treated [ET]) or conventional management (CM), with treatment only if threshold ROP developed.

MAIN OUTCOME MEASURES: Myopia (spherical equivalent >/= 0.25 diopters [D]) or high myopia (>/=5.00 D) at each visit.

RESULTS: Prevalences of myopia were similar in treated eyes in the ET and CM groups, increasing from approximately 58% to 68% between 6 and 9 months, with little change thereafter. Both ET and CM eyes showed an increasing prevalence of high myopia, approximately 19% at 6 months and increasing 4% to 8% at successive examinations. Zone of ROP and presence or absence of plus disease had little effect on prevalence of myopia or high myopia between ages 6 months and 3 years. However, eyes with ROP residua (straightened temporal vessels or macular heterotopia) showed a higher prevalence of myopia and high myopia than eyes without residua.

CONCLUSIONS: Approximately 70% of high-risk prethreshold ROP eyes were myopic in early childhood, and the proportion with high myopia increased steadily between ages 6 months and 3 years. Timing of treatment of high-risk prethreshold ROP did not influence refractive error development. There was little difference in prevalence of myopia or high myopia between eyes with zone I and eyes with zone II ROP, nor between eyes with plus disease and eyes with no plus disease. However, prevalence of myopia and high myopia was higher in eyes with retinal residua of ROP than in eyes with normal-appearing posterior poles, highlighting the importance of follow-up eye examinations of infants who had prethreshold ROP.