Visuopathy of prematurity: is retinopathy just the tip of the iceberg?

Impact This paper proposes that retinopathy of prematurity (ROP) is just the tip of the iceberg of an entity we call visuopathy of prematurity (VOP). VOP comprises the abnormal vascularization of the retina and visual processing abnormalities experienced by children born prematurely, even in the absence of ROP. This article contributes with a new perspective on the existing literature concerning visual abnormalities among children born prematurely. This article presents a new idea regarding the cause of visual abnormalities seen among children born premature, which will guide further research on the topic. Research on retinopathy of prematurity (ROP) focuses mainly on the abnormal vascularization patterns that are directly visible for ophthalmologists. However, recent findings indicate that children born prematurely also exhibit changes in the retinal cellular architecture and along the dorsal visual stream, such as structural changes between and within cortical areas. Moreover, perinatal sustained systemic inflammation (SSI) is associated with an increased risk for ROP and the visual deficits that follow. In this paper, we propose that ROP might just be the tip of an iceberg we call visuopathy of prematurity (VOP). The VOP paradigm comprises abnormal vascularization of the retina, alterations in retinal cellular architecture, choroidal degeneration, and abnormalities in the visual pathway, including cortical areas. Furthermore, VOP itself might influence the developmental trajectories of cerebral structures and functions deemed responsible for visual processing, thereby explaining visual deficits among children born preterm.

Automated summary

This paper proposes the concept of visuopathy of prematurity (VOP) and suggests that visual abnormalities in premature infants go beyond just abnormal retinal vascularization, including visual processing abnormalities and changes in brain structure. Furthermore, it highlights the association between sustained systemic inflammation in premature infants and the risk of ROP and visual deficits.