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Correlation of Recognition Visual Acuity With Posterior Retinal Structure in Advanced Retinopathy of Prematurity

David K. Wallace, MD, MPH; Don L. Bremer, MD; William V. Good, MD; Rae Fellows, MEd; C. Gail Summers, MD; Betty Tung, MS; Robert J. Hardy, PhD
Arch Ophthalmol. 2012;130(12):1512-1516. doi:10.1001/archophthalmol.2012.2118.
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Objective To compare Early Treatment Diabetic Retinopathy Study visual acuity outcome with retinal structural outcome at the 6-year follow-up examination of infants randomized in the Early Treatment for Retinopathy of Prematurity study.

Methods We compared the results in 606 eyes of subjects in whom both functional (visual acuity) and retinal structural assessments were obtained at age 6 years. Visual acuity assessments were performed by masked testers, and retinal examinations were performed by certified ophthalmologists.

Main Outcome Measures Visual acuity and retinal structure at age 6 years.

Results Concordant outcomes occurred in 462 eyes (76.2%): 402 eyes had favorable functional and structural outcomes and 60 eyes had unfavorable functional and structural outcomes. Discordant outcomes occurred in 92 eyes (15.2%): 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 (23 eyes) and/or retinal abnormalities that were less severe than those considered to be unfavorable (32 eyes). In 52 eyes (8.6%), retinal structure could not be assessed or the visual acuity was untestable.

Conclusion Posterior pole appearance correlates well with visual acuity in 6-year-old infants with a history of advanced retinopathy of prematurity.

Application to Clinical Practice When the retinal structure is normal but visual acuity is poor in infants with a history of severe retinopathy of prematurity, other diagnoses such as optic atrophy and cortical visual impairment could at least partially account for the discrepancy.

Trial Registration clinicaltrials.gov Identifier: NCT00027222

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Figures

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Figure 1. Flow diagram showing the follow-up of 401 randomized infants in the Early Treatment for Retinopathy of Prematurity trial at age 6 years. ETDRS indicates Early Treatment Diabetic Retinopathy Study.

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Figure 2. Comparison of retinal structure and visual acuity at the 6-year follow-up examination. ETDRS indicates Early Treatment Diabetic Retinopathy Study; LP, light perception; LVP, low vision card perception only; and NLP, no light perception. Retinal structure summary diagnoses are listed in Table 3.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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