Central macular morphology and optic nerve fibre layer thickness in young adults born premature and screened for retinopathy of prematurity

Publisher Copyright: © 2023 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.Purpose: To investigate central retinal morphology and optic retinal nerve fibre layer (RNFL) in prematurely born young adults and compare to term born controls. Materials and Methods: The participants were 59 prematurely born individuals, with a birthweight ≤1.500 g, and 44 term born controls, all 25–29 years of age. Visual acuity (VA) and contrast sensitivity (CS) were assessed. The retinal macular thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness and RNFL thickness were assessed with Cirrus optical coherence tomography (OCT). Results: Central macular thickness was increased (mean 26.7 μm) in prematurely born individuals compared to controls. The macular GC-IPL was thinner (mean 3.84 μm), also when excluding those with previous retinopathy of prematurity (ROP) and those with neurological complications. Gestational age at birth and previous treatment of ROP were risk factors for a thicker macula, however, not for reduced GC-IPL. The average peripapillary RNFL was thinner (mean 4.61 μm) in the prematurely born individuals, also when excluding those with previous ROP and/or neurological complications. Within the prematurely born group, treated ROP was correlated with increased average RNFL. Further, both better VA and CS were associated with thinner optic nerve RNFL and thicker average GC-IPL. Conclusion: Macular and optic nerve morphology were influenced by premature birth as assessed with OCT in adult individuals. Gestational age at birth and treatment for ROP seemed to affect central macular thickness, and treated ROP affected the peripapillary RNFL. Thus, retinal sequelae remained in adulthood.Peer reviewe

Low Birth Weight Is a Risk Factor for Severe Retinopathy of Prematurity Depending on Gestational Age

Objective: To evaluate the impact of low birth weight as a risk factor for retinopathy of prematurity (ROP) that will require treatment in correlation with gestational age at birth (GA). Study design In total, 2941 infants born <32 weeks GA were eligible from five cohorts of preterm infants previously collected for analysis in WINROP (Weight IGF-I Neonatal ROP) from the following locations: Sweden (EXPRESS) (n = 426), North America (n = 1772), Boston (n = 338), Lund (n = 52), and Gothenburg (n = 353). Data regarding GA at birth, birth weight (BW), gender, and need for ROP treatment were retrieved. Birth weight standard deviation scores (BWSDS) were calculated with Swedish as well as Canadian reference models. Small for gestational age (SGA) was defined as BWSDS less than −2.0 SDS using the Swedish reference and as BW below the 10th percentile using the Canadian reference charts. Results: Univariate analysis showed that low GA (p<0.001), low BW (p<0.001), male gender (p<0.05), low BWSDSCanada (p<0.001), and SGACanada (p<0.01) were risk factors for ROP that will require treatment. In multivariable logistic regression analysis, low GA (p<0.0001), male gender (p<0.01 and p<0.05), and an interaction term of BWSDS*GA group (p<0.001), regardless of reference chart, were risk factors. Low BWSDS was less important as a risk factor in infants born at GA <26 weeks compared with infants born at GA ≥26 weeks calculated with both reference charts (BWSDSSweden, OR = 0.80 vs 0.56; and BWSDSCanada, OR = 0.72 vs 0.41). Conclusions: Low BWSDS as a risk factor for vision-threatening ROP is dependent on the infant's degree of immaturity. In more mature infants (GA ≥26 weeks), low BWSDS becomes a major risk factor for developing ROP that will require treatment. These results persist even when calculating BW deficit with different well-established approaches

Using different definitions affected the reported prevalence of neurodevelopmental impairment in children born very preterm

AimWe investigated the impact of varying definitions on the prevalence of neurodevelopmental impairment (NDI) in children born very preterm at 6.5 years of age.MethodsCognitive development and neurosensory impairments were assessed in 91 children (40/51 girls/boys) born ResultsThe prevalence of severe NDI varied from 2% to 23% depending on the definition used. The prevalence of cognitive impairment varied from 2% (−3 SD according to test norms) to 16% (−2 SD according to control group), the prevalence of cerebral palsy from 0% (severe) to 9% (any) and the prevalence of severe visual impairment from 0% (blindness) to 1% (visual acuity ConclusionA high variability in definitions affects the reporting of the prevalence of NDI in long-term follow-up studies of very or extremely preterm born children. There is a need for a better consensus to enable comparisons across studies.</p

Manager- und transaktionsspezifische Determinanten der Performance von Arbitrage CLOs

Der vorliegende Beitrag untersucht die Determinanten der Performance europäischer Arbitrage Collateralized Loan Obligations für das Jahr 2009. Der Fokus liegt dabei auf der Bedeutung der performanceabhängigen Vergütung des CLO-Managers, den Eigenschaften des CLO-Managers und der Transaktionscharakteristika als mögliche Einflussfaktoren der Rating Performance. Es wird gezeigt, dass Transaktionen, bei denen dem CLO-Manager eine Incentive Management Fee gewährt wird, mit einer höheren Wahrscheinlichkeit herabgestuft werden als Transaktionen ohne Incentive Fee. Dieser Befund bestätigt die Hypothese, dass durch die Incentive Fee Risikoanreize für CLO-Manager geschaffen werden. Des Weiteren wird ein positiver Zusammenhang zwischen der Erfahrung bzw. der Größe eines CLO-Managers und der Rating Performance festgestellt. Der Einfluss des Managers auf die Performance einer CLO-Transaktion wird auch an den weiteren in der Studie herangezogenen managerspezifischen Charakteristika wie Typ und Unternehmenssitz bestätigt. Für die Transaktionscharakteristika wird hingegen im betrachteten Untersuchungszeitraum kein signifikanter Einfluss auf die Rating Performance nachgewiesen

Clinical categories of patients and encounter rates in primary health care – a three-year study in defined populations

BACKGROUND: The objective was to estimate the proportion of inhabitants with a diagnosis-registered encounter with a general practitioner, and to elucidate annual variations of clinical categories of patients in terms of their individual comorbidity. METHODS: A three-year retrospective study of encounter data from electronic patient records, with an annual-based application of the Johns Hopkins Adjusted Clinical Groups (ACG) system. Data were retrieved from every patient with a diagnosis-registered encounter with a GP during the period 2001–2003 at 13 publicly managed primary health care centres in Blekinge county, southeastern Sweden, with about 150000 inhabitants. Main outcome measures: Proportions of inhabitants with a diagnosis-registered encounter, and ranges of the annual proportions of categories of patients according to ACGs. RESULTS: The proportion of inhabitants with a diagnosis-registered encounter ranged from about 64.0% to 90.6% for the primary health care centres, and averaged about 76.5% for all inhabitants. In a three-year perspective the average range of categories of patients was about 0.4% on the county level, and about 0.9% on the primary health care centre level. About one third of the patients each year had a constellation of two or more types of morbidity. CONCLUSION: About three fourths of all inhabitants had one or more diagnosis-registered encounters with a general practitioner during the three-year period. The annual variation of categories of patients according to ACGs was small on both the county and the primary health care centre level. The ACG system seems useful for demonstrating and predicting various aspects of clinical categories of patients in Swedish primary health care

Ophthalmological aspects of prematurity

In a prospective, population-based study of a weIl defined geographical area in Sweden, an ROP incidence of 40.4% was found among 260 prematurely born infants with a birth weight of 1500 grams or less. Cryotherapy was performed in 10.8% of the infants. Gestational age at birth and birth weight were significantly associated with ROP. A 3.5-year ophthalmological foIlow-up of the 260 prematurely bom infants was performed. In the refraction there was a reduction in the mean spherical equivalents with increasing degrees of ROP. Myopia (examination at 2 1/2 years) was commonest in eyes with ROP (18% of light eyesl 15% of left eyes), particularly in those treated with cryo (40%/27%). Astigmatism was associated with ROP, but not with cryotherapy per se. Astigmatism was also associated with low birth weight. Marked anisometropia was related to cryotreated ROP. A visual handicap (visual acuity <0.3) was found in 2.5% of the children and severe visual impairment (visual acuity <0.1) was present in two children (0.8%), of whom one was blind. Neurological complications and the degree of ROP, including cryotreated ROP, were significant risk factors for poor vision. Strabismus, seen in 13.5% of the total study population, was significantly associated with neurologicallesions and their sequelae, anisometropia and cryotreated ROP. Prematurely bom infants without ROP ran an increased risk of myopia, anisometropia and strabismus as compared to a nOlmal population, which emphasizes the need for ophthalmological follow-up of pre term infants even with out ROP. In a selected group of children with pretelm cerebral lesions, visual impailment was commoner in children with ischaemic lesions (leucomalacia and infarcts) than in children with haemonhagic lesions. Pathological"crowding" in visual acuity assessment was also most commonly seen in ischaemic lesions, which implied an overestirnate of vision by tests with solid objects and single optotypes in relation to linear optotype acuity. Difficulties in interpreting complex pietures were found in the whole study group. In a retrospective study of the mothers of infants from the population-based study, essentiai hypertension before pregnancy was the only maternallisk factor associated with ROP in a logistic, multiple regression analysis. Among risk factors for pretelm birth in our population, socioeconomic factors (mmital status and education), as well as smoking, played a less prominent roI e than in previous studies. In a retrospective study of neonatal Ii sk factors in the same population, gestational age at birth, bronchopulmonary dysplasia, and low birth weight were significantly associated with ROP. In both studies, prematmity per se remained the strongest risk factor for ROP. Screening for ROP in our area is recommended for infants with a gestational age at birth of 32 weeks or less, and long-telm opthalmological follow-up is suggested for all of them, with particular emphasis on those infants that run the highest risk of complications - i.e., those who have had cryotherapy and/or have neurological complications

Refraction and its development in young adults born prematurely and screened for retinopathy of prematurity.

PURPOSE: To evaluate refraction and its development in young adults born prematurely, screened for retinopathy of prematurity, and to compare with individuals of the same age born at term. MATERIALS AND METHODS: The participants were 59 preterms, with a birthweight of ≤ 1500 g, and 43 term-born controls, all born during 1988-1990. The refraction was measured in cycloplegia, and the spherical equivalent (SE) was calculated. The axial length (AL), anterior chamber depth and corneal radius (CR) were measured, and the AL/CR ratio was calculated. RESULTS: The mean SE was -0.5 dioptres (D) (SD 2.5) in right eyes (REs) and -0.4 D (SD 2.3) in left eyes (LEs) of preterms, and -0.2 D (SD 1.5) in REs and -0.2 D (SD 1.5) in LEs of controls. The distribution of refraction was wider in the preterm group compared to the control group. In the preterm group, 12% had a SE ≥ 1.5 D, but none of the controls. Ten preterms, but none of the controls, had anisometropia ≥ 1.0 D. The prevalence of astigmatism ≥ 1.0 D was higher in preterms than controls. The SE decreased around 1 D in both preterms and controls from 10 to 25 years of age. The AL and CR were shorter in the preterms; however, the AL/CR ratio was similar in both groups. Within the preterm group, cryotherapy was correlated with astigmatism, but not with SE and anisometropia at this age. CONCLUSION: Prematurely born individuals had higher prevalence of refractive errors in young adulthood compared to term-born controls

Visual function is reduced in young adults formerly born prematurely : a population-based study

Aims To assess visual function in young adults born preterm and compare with full-term individuals of the same age. Methods Young adults, born preterm (birth weight &lt;= 1500 g) in 1988-1990, previously included in a population-based study on the incidence of retinopathy of prematurity (ROP) in Stockholm County, Sweden were included. A control group of participants born at term, in the same area during the same time period, was used for comparison. Best-corrected visual acuities were assessed at distance and near with logMAR charts. Distance visual acuity was also measured with single symbols to calculate crowding. Visual fields were measured with Humphrey 24-2 and the mean deviation was noted. Contrast sensitivity was assessed with Vistech contrast sensitivity test and the area under the curve was calculated. Results Fifty-nine preterm (females 37) and 44 full-term (females 18) individuals were included. All individuals were between 25 and 29 years of age. Preterm individuals had significantly lower distance visual acuity (mean -0.08 (SD 0.11) vs -0.14 (SD 0.07) logMAR, p=0.009), near visual acuity (mean -0.08 (SD 0.11) vs -0.13 (SD 0.06) logMAR, p=0.049), mean deviation (mean -1.09 (SD 1.13) vs -0.80 (SD 1.03) dB, p=0.05) and contrast sensitivity (mean 2.02 (SD 0.19) vs 2.16 (SD 0.14), p&lt;0.001) in the better eye compared with full-term individuals. The differences in distance visual acuity and contrast sensitivity were also evident after excluding persons with previous ROP and neurological complications. In multivariable analyses, treated ROP was a risk factor for reduced near visual acuity and visual fields. Conclusion Visual function seems to be reduced in prematurely born individuals even in adulthood. The reason may be prematurity per se since individuals without previous ROP or neurological complications are also affected. Synopsis Visual function, assessed as visual acuity, visual fields and contrast sensitivity, was reduced in young adults born preterm and previously included in a population-based study on the incidence of retinopathy of prematurity, as compared with controls