The significance of ocular morbidity in very-low-birthweight infants to the Australian health service.

The survival rate of very-low-birthweight (VLBW) infants has greatly increased due to the introduction of intensive-care methods to neonatal nurseries. It was feared that this would also cause an increase in the amount of ocular morbidity associated with prematurity. In order to estimate this, 111 very-low-birthweight infants (birthweights less than or equal to 1500 g) were reviewed at two years of age. They comprised 63% of the total number of long-term surviving babies born at, or transferred in the neonatal period to, the Royal Women's Hospital, Melbourne, in 1977 and 1978. In 33% a significant ocular problem was detected; 19% had strabismus, 17% had a significant refractive error, 10% had cicatricial retrolental fibroplasia (RLF), and 2.7% were blind, due to optic atrophy associated with cerebral palsy. Other studies have shown that 7% of VLBW infants develop severe (Stage III) RLF, and 18% of these (1.26% of VLBW infants) will be socially or totally blind. In order to estimate the significance of VLBW infants to the ophthalmic health services, and to the organisations for the care of the visually handicapped, these figures can be extrapolated. Based on 1980 figures, it would be expected that approximately 1105 VLBW infants would survive annually, and nine would become blind from RLF, while 110 would have been affected by RLF. Thirty-three children would be blind from optic atrophy associated with cerebral palsy, 210 would have strabismus, and at least 187 would have a significant refractive error. VLBW infants will contribute significantly to the number of children requiring ocular care, and because of the high incidence of ocular abnormalities, it is recommended that routine screening of all VLBW infants be carried out at one year and two years of age.