Prediction of Visual Function in Eyes with Mild to Moderate Posterior Pole Residua of Retinopathy of Prematurity

The Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) assigned eyes with macular heterotopia to the “favorable” outcome category and eyes with retinal fold involving the macula to the “unfavorable” outcome category. This binary assignment did not agree well with measured visual acuity outcome. We tested the hypothesis that rating structural outcome on a continuum from less to more severe would improve prediction of visual acuity in eyes with macular heterotopia or retinal fold. Fundus photographs of the 69 eyes in the CRYO-ROP trial that had macular heterotopia (n=55) or retinal fold (n=14) at the 1-year follow-up were analyzed for severity of macular heterotopia, macular elevation, and pigmentary disturbances. Each physician author estimated each eye's predicted Snellen acuity, based on the photographic findings and clinical expertise. These results were compared with the grating acuity obtained at ages 1 and 31/2 years with the Teller Acuity Card procedure and with letter acuity obtained at age 31/2 years with the crowded HOTV test. The 69 eyes were from 59 patients in the randomized portion of the CRYO-ROP trial. Although eyes with retinal fold tended to have greater visual impairment than eyes with macular heterotopia, there was a wide variation in acuity in both groups, and physicians were unable to predict visual acuity from retinal appearance. The physician cannot reliably predict either grating acuity or letter acuity in eyes with macular heterotopia or macular fold due to retinopathy of prematurity. There is no substitute for periodic visual acuity testing in these eyes.