Children diagnosed with retinopathy of prematurity (ROP) who undergo treatment face a significantly higher risk of developing strabismus compared to those who do not, according to a study published in the American Journal of Ophthalmology. Researchers analyzing a cohort of 27,720 pediatric patients found that 34.78% of treated children developed strabismus within five years, compared to 22.14% of untreated patients.
Why does ROP treatment increase strabismus risk?
The elevated risk of strabismus in treated patients likely reflects the severity of the underlying retinal disease rather than the intervention itself, according to the study authors. Clinical data indicates that children requiring laser photocoagulation or intravitreal (IVT) anti-vascular endothelial growth factor (anti-VEGF) injections likely had more severe baseline retinal disease. Researchers identified treatment exposure as an independent risk marker, with a multivariable Cox proportional hazards model showing an adjusted hazard ratio (aHR) of 1.58 for strabismus development.
How do comorbidities influence long-term eye health?
The study, which utilized the TriNetX U.S. Collaborative network, found that concurrent ocular conditions significantly compound the risk of strabismus. Amblyopia was identified as the strongest correlate, carrying an aHR of 2.58, followed by nystagmus at 1.76. Other conditions, including lens disorders (aHR 1.61) and optic nerve or visual pathway disorders (aHR 1.55), were also independently associated with a higher hazard. Conversely, conditions like glaucoma and history of eye and orbit injury did not show a statistically significant association with strabismus in this specific cohort.
What does this mean for clinical surveillance?
Because children with ROP remain at elevated risk for ocular alignment disorders well beyond infancy, early ophthalmic screening alone won’t catch every case. The investigators recommend structured, longitudinal surveillance of ocular alignment throughout early childhood. This is particularly critical for patients who have already been diagnosed with amblyopia or nystagmus. The study results remained consistent even when researchers restricted the cohort to children aged 4 years or younger, reinforcing the need for persistent follow-up protocols.
Pro Tips for Parents and Caregivers
- Don’t skip follow-ups: Even if a child’s ROP appears resolved, the risk of strabismus persists for years.
- Monitor for alignment changes: Watch for signs of “crossed eyes” or eyes that do not move in unison.
- Advocate for screenings: Ensure your ophthalmologist is aware of the child’s ROP history during every routine visit.
Frequently Asked Questions
Does laser surgery directly cause strabismus?
The study authors suggest the increased risk is linked to the severity of the infant’s initial retinal disease—which necessitates the intervention—rather than the intervention itself.
At what age does the risk of strabismus peak?
The study tracked outcomes up to five years post-diagnosis, showing that the cumulative incidence of strabismus in the treated group rose steadily from 15.97% at one year to 34.78% at five years.
Are all children with ROP at the same risk?
No. The study found that children who required treatment (laser or anti-VEGF) had a markedly higher hazard compared to those with untreated ROP.
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