Visual function in low birthweight children

AIM: To determine the visual functions, at age 10-12 years, of a geographically based cohort of children of birth weight less than 1701 g. The results were compared to a group of children born at full term. METHODS: 572 low birthweight (LBW) "low birthweight cohort" children who had been examined in the neonatal period were invited for review at 10-12 years of age. 169 11 year old schoolchildren born at full term were also recruited, "school cohort." Visual acuity (at distance and near), contrast sensitivity, colour vision, and visual fields were measured. RESULTS: 293 of the original 572 participants consented to a further examination. Compared to the school cohort of children born at term the low birthweight cohort showed significantly lower near and distance acuities and contrast sensitivity (p<0.001 for all uniocular and binocular measures). Retinopathy of prematurity (ROP) was a very poor predictor of outcome and multivariate analysis did not identify any key neonatal factors as predictors of long term visual outcome. CONCLUSIONS: Low birthweight children have a small but statistically significant deficit in both visual acuity and contrast sensitivity. Low birth weight and ROP both impact on long term visual functions.     

Accommodation and convergence in 10-year-old prematurely born and full-term children-a population-based study

Purpose: To examine the accommodative amplitude and convergence in 10-year-old prematurely born children previously screened for retinopathy of prematurity (ROP) and to compare with full-term controls of the same age. Methods: Two-hundred and thirteen prematurely born and 217 children born at term were included. Accommodative amplitude and near-point convergence were assessed, together with best-corrected visual acuity (VA). A questionnaire was answered regarding possible problems at school. Results: Binocular accommodation (P = 0.03) and convergence (P = 0.003) were significantly poorer in prematurely born children. Accommodation was correlated to neurological findings in the preterm group, but not to the degree of prematurity or stage of ROP. Regarding convergence there were no correlations to neurology, stage of ROP, or degree of prematurity. For neither accommodation nor convergence were any correlations with distance and near VA found. Preterm children had a higher prevalence of school problems, and there was an association with poor accommodation. Conclusions: Prematurely born children had poorer accommodation and convergence than full-term children, but no association with near VA was found. The reduction of accommodative amplitude and convergence was small and was probably of little clinical significance. However, it may have additional effects on other ophthalmological problems and school problems in the preterm group.     

Ophthalmological follow up of preterm infants: a population based, prospective study of visual acuity and strabismus

BACKGROUND/AIMS: Prematurely born infants are known to have an increased rate of ophthalmological morbidity. The aim of the present study was to investigate visual acuity and ocular alignment in a population of preterm infants in a geographical area, in infants with and without retinopathy of prematurity (ROP). METHODS: A prospective population based study of ophthalmological status of preterm infants with a birth weight of 1500 g or less was performed during 3.5 years, with examinations at 6, 18, 30, and 42 months of corrected age. Visual acuity was tested using linear optotypes. Multiple regression analyses were used to analyse independent risk factors for poor vision and strabismus. RESULTS: Poor vision (< 0.3) was detected in 2.5% (6/237) of the children. Of these, only two (0.8%) had a severe visual impairment (< 0.1). Strabismus occurred in 13.5% (31/229). Children with cryotreated ROP and neurological complications ran the highest risk of poor vision and strabismus, according to multiple regression analysis. Among children without a history of ROP or neurological complications, 34% had a visual acuity < 0.7 and 5.9% had strabismus, compared with 61% and 22%, respectively, among the children with ROP or neurological complications. CONCLUSIONS: The overall incidence of subnormal vision and strabismus in children born prematurely was higher than in a full term population of the same age. On the basis of this study, follow up of all preterm infants screened for ROP is recommended and general guidelines are suggested.     

早产对无早产儿视网膜病变的早产儿眼发育和发病的影响

目的调查无早产儿视网膜病变（ROP）的学龄前和学龄期早产儿的眼球发育和发病率。方法对26名5～7岁无ROP的早产儿童进行全面的眼科检查,包括矫正视力、散瞳验光、色觉以及眼前后段检查。测量数据包括前房深度、晶体厚度、玻璃体长度和眼轴长度。结果早产儿视力和屈光状态之间没有相关性。2名（7.7%）有斜视,2名（7.7%）有弱视,3名（11.5%）有屈光参差。眼轴长与胎龄（r=0.822,P〈0.001）和胎重（r=0.569,P=0.003）有相关性,玻璃体长度与胎龄（r=0.744,P〈0.001）和胎重（r=0.553,P=0.004）有相关性。讨论本研究显示眼球的增长是因为胎龄和胎重增加,但这种情况不会导致明显的屈光不正。通过文献对比,无ROP的早产儿童的斜视、弱视和屈光参差的发病率要明显高于同年龄段的正常儿童。     

Cataract surgery in children with and without retinopathy of prematurity

PURPOSE: To report the outcomes of cataract surgery in children born prematurely who had or did not have retinopathy of prematurity (ROP). SETTING: Seoul National University Hospital, Department of Ophthalmology, Seoul, Korea. METHODS: Retrospective studies were conducted by reviewing the charts of 26 eyes of 14 premature infants with or without ROP that had cataract surgery. The patients' preoperative characteristics and postoperative visual outcomes were documented. Cataract surgery consisted of lensectomy, posterior capsulectomy, and anterior vitrectomy in patients younger than 2 years and primary posterior chamber intraocular lens (PC IOL) implantation or secondary PC IOL implantation in those 2 years or older. Postoperative optical correction in those younger than 2 years was by glasses or contact lenses. RESULTS: Eight eyes of 5 patients had acute ROP; 4 eyes had stage 3, 2 had stage 2, and 2 had stage 1. Three eyes had transconjunctival cryotherapy for treatment of threshold ROP. First-eye cataract surgery were performed in children from 0.2 to 5.5 years old (mean 1.5 years) and second-eye surgery, in children from 1.8 to 12.1 years old (mean 4.3 years). Twenty eyes had implantation of a PC IOL. In 1 patient with stage 3+ ROP, Rush (plus) type, both eyes had combined cataract and scleral buckle encircling surgery. The mean follow-up after the last surgery was 1.4 years (0.5 to 3.1 years). At the last examination, the best corrected visual acuity was good fixation or better than 20/80 except in 2 eyes, 1 with esotropia and the other with a dense pupillary membrane. CONCLUSIONS: This is the first report of an encouraging surgical outcome for PC IOL implantation in premature infants with cataract regardless of the presence of ROP. However, if retinopathy is present and has progressed in the cataractous eye of a premature child, careful examination and timely surgical decisions are important.     

Ophthalmological long term follow up of preterm infants: a population based, prospective study of the refraction and its development

BACKGROUND—Numerous studies have reported an increased risk of refractive errors in prematurely born infants, but only few have been long term and strictly population based.
METHODS—A 3.5 year ophthalmological long term follow up of 248 preterm infants was performed. The infants had been included in a previous epidemiological study of retinopathy of prematurity (ROP) (birth weight  1500 grams). The incidence of refractive errors and development of refraction were studied, based on retinoscopies at 6 and 30 months of corrected age.
RESULTS—The overall incidence of myopia was 8% at 6 months, of which 35% was transient, and 10% at 30 months. Of the cryotreated infants, 30-40% were myopic at both retinoscopies. The incidence of astigmatism was 52% at 6 months and 26% at 30 months. Astigmatism was associated with ROP, but not with cryotreated ROP itself. Astigmatism "against the rule" was commoner than astigmatism "with the rule". Anisometropia occurred in 6.5% of the infants at 6 months and in 8.4% at 30 months. The incidence of anisometropia was higher in eyes with ROP, particularly in cryotreated eyes, which tended to have high and persistent anisometropia.
CONCLUSION—The risk of refractive errors is higher in preterm infants than in infants born at term, and also prematurely born infants without ROP do run an increased risk of having myopia and anisometropia. We recommend follow up examinations with retinoscopy for all infants included in screening programmes for ROP.

Keywords: prematurity; prospective study; retinopathy of prematurity; refraction     

Visual impairment in children born prematurely from 1972 through 1989

PURPOSE: To investigate the incidence and causes of visual impairment in children born prematurely in Finland from 1972 through 1989, and to determine what conditions and factors were associated with its occurrence. DESIGN: Retrospective, cross-sectional study. SUBJECTS: All visually impaired individuals from 0 to 17 years of age who had been born at fewer than 37 gestational weeks in Finland from 1972 through 1989 for whom records were available in the Finnish Register of Visual Impairment were eligible for this study. METHODS: Data in the Finnish Register of Visual Impairment relating to 556 children were supplemented with data from hospital records, and from the Register of Births, the Register of Congenital Malformations, the Finnish Care Register, and the Finnish Cancer Register. Data relating to causes associated with visual impairment in particular were collected. Data relating to the children born prematurely were compared with data relating to children born at full term. The chi-square test (Mantel-Haenszel), the Mann-Whitney U test, Fisher exact test, and stepwise logistic regression analysis were used in statistical analysis of the data. MAIN OUTCOME MEASURES: Visual acuity, ophthalmologic diagnoses, associated systemic disease, multiple handicap, gestational age, birth weight, 5-minute Apgar scores, and prenatal, perinatal, and infantile or juvenile disorders or disease and treatment. RESULTS: One hundred twenty-five of the 556 visually impaired children (23%; 11/100000 children less than 18 years of age) had been born preterm. Retinopathy of prematurity, optic atrophy, and cerebral amblyopia were the main diagnoses associated with visual impairment (in 46%, 28%, and 12% of cases, respectively). Sixty-six percent of those born prematurely with visual impairment were also affected by other handicaps (mental, motor, auditory), 54% by cerebral palsy and 36% by epilepsy. Eighty-eight of the 125 children (70%) born preterm with visual impairment were blind. Very low birth weight (<1500 g), young gestational age (fewer than 30 weeks), prenatal infection, hyperbilirubinemia, respiratory disorders, asphyxia, and lengthy mechanical ventilation were associated with an increased risk of visual impairment. CONCLUSIONS: Premature birth was a major risk factor of severe visual impairment and blindness in childhood. The visual impairment often was accompanied by cerebral palsy, epilepsy, and other motor and mental handicaps. Retinopathy of prematurity, optic atrophy, and cerebral amblyopia were the main diagnoses associated with visual impairment. During the 18 years covered by the study, the increasing incidence of survival of infants born weighing fewer than 1500 g was associated with increasing incidence of blindness.     

Risk factors for strabismus in children born before 32 weeks' gestation

AIM: To investigate risk factors associated with strabismus in children born prematurely. METHODS: Prospective study of all children born before 32 weeks' gestation between 1 January 1990 and 31 December 1991 in a geographically defined population of approximately 3 million in the Northern Region of the United Kingdom. All children were examined aged 2 years by the same ophthalmologist and paediatrician. RESULTS: 558 children (98.6% of study group) were examined. Logistic regression showed an increased risk of strabismus in children with cicatricial retinopathy of prematurity (p=0.02), refractive error (p=0.003), family history of strabismus (p<0.0001), and poor neurodevelopmental outcome (p<0.0001), in particular impaired locomotor skills (p=0.008) and hand-eye coordination (p=0. 001). Gestational age and regressed acute ROP were not independent risk factors for strabismus (p=0.92 and 0.85 respectively). CONCLUSIONS: This study has identified factors which are independently related to strabismus (although not necessarily causative) and others which are related only indirectly. This may contribute both to the management of children born prematurely and to future studies of the aetiology of strabismus.     

Early-onset refractive accommodative esotropia.

INTRODUCTION: We studied the natural history of pure refractive accommodative esotropia after spectacle correction in patients with onset before 1 year old to determine whether their outcomes and characteristics were different from those of patients with more typical age at onset of refractive accommodative esotropia. METHODS: We retrospectively reviewed the charts of 17 children with onset of refractive accommodative esotropia before 1 year old. Records of 26 children with onset after 2 years old were reviewed as controls. RESULTS: The mean ages at diagnosis were 9 months and 48 months for the study and control groups, respectively. All 17 study patients and all 26 control patients were initially well aligned with spectacles at distance and near. Follow-up averaged 34 months for study patients and 41 months for control patients. Three study patients (17.6%) and 1 control patient (3.8%) had eventual deterioration and required strabismus surgery (P = .28). None of the study patients developed amblyopia, whereas 42% of control patients did (P = .001). Seven of 15 (47%) of the study patients with known birth history were born prematurely, whereas only 3 of 24 (12%) control patients were born prematurely (P = .03). CONCLUSIONS: Refractive accommodative esotropia was diagnosed at as early as and age 4 months. Prematurity appeared to be a risk factor. Amblyopia was not detected in any patient with early-onset refractive accommodative esotropia. Treatment with full hyperopic spectacle correction led to long-term stable alignment, with relatively few patients requiring surgery.     

Effects of higher-order aberrations on contrast sensitivity in normal eyes of a large myopic population

AIM: To study the relation between higher-order aberrations (HOAs) and contrast sensitivity (CS) in normal eyes among a population of laser in situ keratomileusis (LASIK) candidates. METHODS: In 6629 eyes of 3315 LASIK candidates, CS were measured under dark environment at the spatial frequencies of 1.5, 3, 6, 12 and 18 cycles per degree (c/d), respectively, using an Optec 6500 visual function tester. Meanwhile, ocular HOAs were measured for a 6.0 mm pupil with a Hartmann-Shack wavefront analyzer. RESULTS: In the study, the subjects with an average spherical equivalent of -4.86±2.07 D were included. HOAs decreased from the third to the sixth order aberrations with predominant aberrations of third-order coma, trefoil and fourth-order spherical aberration. At low and moderate spatial frequencies, CS was negatively correlated with the third-order coma and trefoil aberrations, and decreased with increasing Z31, but increased with increasing Z3-3 and Z5-1. At high spatial frequencies, CS decreased with increasing Z3-3 and increased with increasing Z5-1. CONCLUSION: At a large pupil size of 6.0 mm, the third-order aberrations, but not the total aberrations, are the main factors affecting CS. Vertical coma is negatively correlated with CS.     

Braille use among Norwegian children from 1967 to 2007: trends in the underlying causes

Purpose: The aim of the study was to estimate the occurrence, diagnoses and time trends among Norwegian children that have received education in braille from 1967 to 2007. Methods: We used a retrospective population‐based study design. The health care system is free for all inhabitants in Norway. We included all children that had received braille education the last four decades. From each student’s record, we abstracted year born, country of birth, gender, year diagnosed, diagnosis, classification of visual impairment and type of reading media. Results: We identified 287 children (137 girls and 150 boys) that had received braille education over the last 40 years. Of these, 262 (91.3%) children were born in Norway, 145 (53.7%) were diagnosed within the first year of life and 59 (20.6%) from age of one to five. The most frequent diagnoses were Retinopathy of Prematurity (ROP), Juvenile Ceroid Lipofuscinoses (JNCL), Lebers Congenital Amaurosis (LCA) and Retinitis Pigmentosa (RP). Among the children, 63% (N = 170) used braille only, 9% (N = 25) braille and print, but priority braille, and 27% (N = 73) braille and print, priority print. The number of children with ROP using braille had a peak in 1977, then the number declined. The number diagnosed with LCA increased from 1987 to 1992. The number of braille users among children diagnosed with JNCL tended to increase substantially after 1992. Conclusion: Braille education seemed to be dependent of trends in diagnoses as well as trends in recommendations from professional educators.     

Emmetropisation following preterm birth

BACKGROUND/AIMS: Even in the absence of retinopathy of prematurity (ROP), premature birth signals increased risk for abnormal refractive development. The present study examined the relation between clinical risk factors and refractive development among preterm infants without ROP. METHODS: Cycloplegic refraction was measured at birth, term, 6, 12, and 48 months corrected age in a cohort of 59 preterm infants. Detailed perinatal history and cranial ultrasound data were collected. 40 full term (plus or minus 2 weeks) subjects were tested at birth, 6, and 12 months old. RESULTS: Myopia and anisometropia were associated with prematurity (p<0.05). More variation in astigmatic axis was found among preterm infants (p<0.05) and a trend for more astigmatism (p<0.1). Emmetropisation occurred in the preterm infants so that at term age they did not differ from the fullterm group in astigmatism or anisometropia. However, preterm infants remained more myopic (less hyperopic) than the fullterm group at term (p<0.05) and those infants born <1500 g remained more anisometropic than their peers until 6 months (p<0.05). Infants with abnormal cranial ultrasound were at risk for higher hyperopia (p<0.05). Other clinical risk factors were not associated with differences in refractive development. At 4 years of age 19% of the preterm group had clinically significant refractive errors. CONCLUSION: Preterm infants without ROP had high rates of refractive error. The early emmetropisation process differed from that of the fullterm group but neither clinical risk factors nor measures of early refractive error were predictive of refractive outcome at 4 years.     

The estimation of selected parameters in antioxidant system in red blood cells in ROP screening of premature infants

PURPOSE: To estimate correlation between concentration of antioxidant system parameters in red blood cells in premature infants and prevalence of ROP MATERIAL AND METHODS: We examined 16 premature infants with the average birth weight of 1071 g and gestational age of 29.1 weeks. Supraoxide dismutase (SOD), reduced glutatione (GSH), and glutathione peroxidase (GSH-Px), were measured at day 1 (cord blood), 7-th and 14-th day after birth. Premature infants had ROP screening. The control group included 12 infants born at term. RESULTS: 8 premature infants had ROP There were higher levels of SOD, GSH and GSH-Px in premature infants with and without ROP than in control group. Premature infants with ROP had lowest levels of GSH. Conclusions: The glutathione status of red blood cells as a oxidative stress index in premature infants might be a reliable parameter, facilitating the early recognition of patients in immediate danger of ROP development.     

Visual deficits in children born at less than 32 weeks' gestation with and without major ocular pathology and cerebral damage.

AIMS--A study was carried out to compare the visual abilities of prematurely born children with those of matched full term controls. METHODS--The vision of 68 children born at less than 32 weeks' gestation and aged between 5 and 7 1/2 years at the time of testing was compared with that of a control group of children born at full term, and matched for sex and age from due date. RESULTS--The premature children had significantly poorer distance and near visual acuity, contrast sensitivity and stereopsis, and a high incidence of colour vision defects (predominantly tritan type). These differences were associated with the high incidence of ocular pathology experienced by 31 (45%) of the premature children compared with only nine (13%) of the controls. When excluding children with ocular and cerebral pathology, 32 matched pairs of premature and control children remained. The 32 premature children did not differ from their controls in terms of distance and near acuities or stereopsis, but they did have significantly poor contrast sensitivity in both their 'best' and 'worst' eyes. None of the 32 control children had colour vision defects, compared with seven of the matched premature children. CONCLUSION--This adds support to previous speculation that the preterm eye is at risk of subtle visual impairment independent of the occurrence of refractive error, manifest squint, disorders of the fundus and media, and cerebral damage.     

Incidence of retinopathy of prematurity in extremely premature infants over an 18-year period

Background: To report the incidence of retinopathy of prematurity (ROP) in a subgroup of extremely premature infants admitted to an Australian tertiary centre over an 18‐year period. Design: Retrospective study. Royal Brisbane and Women's Hospital Neonatal Intensive Care Unit. Participants: Five hundred and fifty‐four infants admitted between 23 and 25.6 weeks gestational age (GA). Methods: The 18‐year study was divided into three 6‐year periods for analysis: period 1 (1992–1997), period 2 (1998–2003) and period 3 (2004–2009). Infants were compared based on their week of GA and by the study period in which they were born. Main Outcome Measures: GA, birthweight, incidence and severity of ROP. Results: Three hundred seventy‐three (67.3%) infants survived until ROP screening, and 351 (63.4%) survived until discharge. ROP incidence increased from 78.2% in period 1 to 86.1% in period 3. Over the entire study, 90.5% of 23‐week GA infants had ROP compared with 89.7% of 24‐week GA infants and 76.1% of 25‐week GA infants. Mean birthweight was significantly lower in infants with any ROP (725.1 g) and ROP of at least stage 3 (720.8 g) compared with infants without ROP (806.5 g) (P < 0.0001). Twenty‐three–week GA infants had more severe ROP (28.6%) than 24 weeks (18.3%) and 25 weeks GA (11.9%). Conclusions: There has been increased survival and incidence of ROP in extremely premature infants over the past 20 years. Lower birthweight and GA are both associated with higher incidence and more severe ROP.     

Visual function in 6 to 7 year‐old children born extremely preterm: a population‐based study

Purpose: Progress in neonatal care has caused an increased survival of children born extremely preterm. The aims of this study were to examine the long‐term visual function and ocular development in an unselected cohort of extremely preterm infants and relate the results to neonatal morbidity and long‐term neurodevelopmental outcome. Methods: All children with gestational age of 22–27 completed weeks or birth weight of 500–999 g born in the years 1999–2000 in two counties of Western Norway (n = 52) were invited to an eye examination that included visual acuity, refractive error, binocular function, accommodative amplitude and fundus examination. Cognitive function was assessed with the WPSSI‐R test and motor abilities with the ABC movement test. Results: Neonatal morbidities and neurodevelopmental outcome were known for all, while 37 of the 52 children underwent the eye examination. None were blind or visually impaired, but 46% had subnormal visual acuity (logMAR ≥0.1). Ninety per cent were emmetropic or slightly hypermetropic (0 to +3D), while 10% had manifest and 51% latent strabismus. Performance IQ on the WPSSI‐R test and ABC total score were associated with best visual acuity (p = 0.03 and p < 0.01, respectively). In a multiple linear regression model, visual acuity in the best eye was significantly associated with performance IQ (p = 0.03) and ABC total score (p = 0.02). Conclusion: This study suggests a more favourable long‐term prognosis on important ocular and visual parameters in survivors of extreme prematurity than expected from similar reports on children born less prematurely and that performance IQ and motor function are related to visual acuity.     

Delayed luminance and chromatic contrast sensitivity in infants with spontaneously regressed retinopathy of prematurity

Background

The current study assessed whether contrast sensitivity is affected in preterm infants with a history of spontaneously regressed retinopathy of prematurity (ROP, Stages 1–3). Specifically, we employed luminance (light/dark) and chromatic (red/green) stimuli, which are mediated by the magnocellular (M) and parvocellular (P) subcortical pathways, respectively.

Methods

Contrast sensitivity (CS) was measured using forced-choice preferential looking testing in 21 infants with a history of ROP and 41 control preterm infants who were born prematurely but did not develop ROP, tested between 8 and 47 weeks (2–11 months) postterm age. Infants were presented with chromatic and luminance drifting sinusoidal gratings, which appeared randomly on the left or right side of the monitor in each trial. The contrast of the stimuli varied across trials and was defined in terms of root mean squared cone contrast for long- and medium-wavelength cones.

Results

Between 8 and 25 weeks postterm, ROP infants had significantly worse CS, and there was a trend for greater impairment for luminance than chromatic CS. This delay was not seen at older ages between 26 and 47 weeks postterm.

Conclusions

These findings are consistent with the concept that early maturation of the M pathway is vulnerable to biological insult, as in the case of ROP, to a greater extent than in the P pathway.     

Vision-related Quality of Life in Malaysian Children with Threshold and Prethreshold Retinopathy of Prematurity

PurposeThe prevalence of retinopathy of prematurity (ROP) is higher in developing countries compared to developed countries. There is limited data on vision-related quality of life (VRQoL) among children with severe type of ROP in developing countries. This study evaluated the influence of threshold and prethreshold ROP on VRQoL in Malaysian children.MethodsMulticenter prospective cross-sectional study conducted in three tertiary hospitals in 2018 to 2019. Children less than 7 years old with previous ROP diagnosis were recruited. Patients with systemic comorbidities that affected vision or daily activities were excluded. A parent or guardian completed the Children’s Visual Function Questionnaire (CVFQ) for the assessment of child’s general health, general vision, competence, personality, family impact, and treatment difficulty.ResultsEight were categorized with threshold ROP, 16 with high-risk prethreshold ROP, and 26 with low-risk prethreshold ROP. Fifty age-matched controls were also included. Mean visual acuity in logarithm of the minimum angle of resolution was 0.46 in the threshold, 0.08 in high-risk prethreshold, and 0.01 in low-risk prethreshold subgroups. Threshold ROP was associated with myopia and strabismus, and associated with poor visual acuity compared to prethreshold ROP. Mean total CVFQ score was significantly lower in the ROP group (p < 0.001) compared to the control group. Mean score and all mean subscale scores were significantly lower in the threshold subgroup compared to high-risk and low-risk prethreshold subgroups, with lowest subscale scores on general vision and general health. There was significant association between gestational age, visual acuity of the better eye, family income, and VRQoL (p < 0.05).ConclusionsROP was associated with lower VRQoL in children born prematurely in Malaysia. The threshold ROP group is the most affected. General vision and health domains are their main difficulties encountered. Gestational age, visual acuity of the better eye, and family income affects the VRQoL.     

Effectiveness and future implications of COVID-19-related risk stratification for managing retinopathy of prematurity: The Indian twin cities retinopathy of prematurity study report number 10

Purpose:To evaluate the effectiveness and future implications of COVID-related risk stratification for managing retinopathy of prematurity (ROP).Methods:A prospective study was conducted at a tertiary eye care center from the beginning of the lockdown in India from 23 March 2020 till the end of the first phase of lockdown on 29 May 2020. We evaluated 200 prematurely born infants (< 34 weeks of gestational age) using the new safety guideline protocols for low-risk babies developed in conjunction with the Indian ROP Society for care during the COVID-19 pandemic. Low risk included babies born at more than 30 weeks of gestational age, post menstrual age 34 weeks or above at presentation, more than 1000 grams of birth weight, and stable systemically with good weight gain.Results:New guidelines were implemented in 106 (53%) infants who were low risk while 94 (47%) infants with high risk were followed up as per the old guidelines. Out of the 106 infants (212 eyes) managed by the new guidelines, good outcome (group 1) was seen in 102 (96.2%) infants. Twenty-seven of the 102 infants had some form of ROP and 5 of these infants needed treatment. None of the low-risk babies with no detachment at presentation managed by new guidelines required surgery later (group 2). Two (1.9%) infants came with retinal detachment at presentation and underwent successful surgery (group 3) and two infants (1.9%) were lost to follow up.Conclusion:New risk stratification during the COVID-19 pandemic was an efficient and safe strategy in managing low-risk ROP babies.