Babies born early are at risk of developing retinopathy of prematurity (ROP), one of the most common avoidable causes of childhood blindness globally. If detected early it can be treated by laser or injections into the eye. Research funded by NERC is aiming to use a novel approach to better predict which infants are at highest risk.

Currently UK guidelines recommend screening all babies born earlier than 32 weeks gestational age or with a birth weight under 1501 grams. These guidelines aim for 100% detection rate for severe ROP so no child misses treatment. However less than 10% of screened children require treatment.

While current clinical examinations of the surface of the retina using funduscopy or photography can diagnose ROP it cannot predict whether infants will develop ROP later. However, preliminary data indicate that changes measured with optical coherence tomography (OCT) have good potential to predict later occurring severe ROP.

OCT visualises structures of the eye at near-microscopic levels including the optic nerve and retina. Children have been deprived of this technique as they cannot cooperate with standard table mounted instrument. Recently a hand-held OCT suitable for small infants has become available. The scan can be done in less than 2 seconds without touching the child’s eye.

Professor Irene Gottlob at the University of Leicester, were the first to use this in Europe and among the first worldwide. They have large technical and clinical experience with hand-held OCT and have shown good feasibility and reliability in childhood eye conditions. In prematurity the team have shown excellent feasibility of hand-held OCT of babies within the neonatal intensive care unit.

Preliminary data strongly suggest that early OCT examination of the optic nerve can predict the later occurrence of severe ROP. In the current study, Professor Gottlob will investigate whether the addition of optic nerve and retinal parameters measured with OCT alongside currently used indicators (gestational age at birth, birth weight and weight gain) can increase the specificity of detecting premature infants at highest risk of sight-threatening ROP. During the study, 306 infants from two neonatal care units in the UK - in Leicester and Bristol.

This study can potentially reduce the number of screening examinations required to identify infants most at risk of developing severe ROP, subsequently also reducing stress for infants and healthcare costs. They anticipate the study will be an important step towards understanding eye development in premature infants with the potential to influence future clinical guidelines.

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