Prematurity Plays Role in Strabismus, ROP Status Linked to Higher Rates

This study’s results indicated an 8% increase in the odds of having strabismus with each week of birth before the full gestation of 40 weeks, independent of the occurrence of ROP and/or ROP treatment. Photo: Fieß A, et al. Br J Ophthalmol. October 9, 2025. Click image to enlarge. Strabismus, a known complication of preterm birth, greatly affects visual quality of life. While extremely preterm birth (≤28 weeks) is linked to strabismus, data on moderate to late preterm birth (28 to 36 weeks) and specific types like esotropia and exotropia remain limited. In a recent study published in British Journal of Ophthalmology, researchers in Germany assessed the prevalence of strabismus and its subtypes (esotropia and exotropia) as well as the prevalence of nystagmus in a large cohort of children and adolescents between the ages of four and 17, stratified for stages of preterm birth, retinopathy of ROP with and without treatment and the impact of factors related to prematurity.The team found that the prevalence of strabismus and nystagmus was highest in children born preterm with treated ROP. Strabismus was generally diagnosed before age five, with the earliest diagnoses in children with ROP (median: one year). In contrast, children born moderately or extremely preterm were often diagnosed later (median: three to four years).“Early diagnosis and regular eye care monitoring are essential not only for children with ROP but also for those born preterm without it—including those born moderately preterm—to avoid delays in amblyopia treatment and improve long-term visual outcomes,” the study authors wrote in their paper. “Prematurity, particularly in cases involving ROP, plays a significant role in the development of strabismus, with the strongest associations observed with lower geographic atrophy (GA) and refractive errors, such as anisometropia and astigmatism.”This retrospective cohort study included 1,889 eyes of 949 children (average age 11.2 years, 52.2% female). Participants were divided into the following groups: controls born at term (GA ≥37 weeks, group 1), children born preterm without ROP and GA 33 to 36 weeks (group 2), GA 29 to 32 weeks (group 3), GA ≤28 weeks (group 4), GA ≤32 weeks with untreated ROP (group 5) and GA ≤32 weeks with treated ROP (group 6). Strabismus was observed in 6% of children in group 1, 10% in group 2, 12% in group 3, 23% in group 4, 20% in group 5 and 68% in group 6. Nystagmus was observed in 0.8%, 0.4%, 1.8%, 2.6%, 5.0% and 47% in the respective groups.Strabismus was associated with earlier GA (odds ratio; OR=1.08), astigmatism (OR=2.48) and hypermetropia (OR=2.09). Esotropia was associated with weeks of prematurity (OR=1.11), anisometropia (OR=3.09) and hypermetropia (OR=4.17). Nystagmus was associated with ROP (OR=7.49), anisometropia (OR=5.17) and myopia (OR=11.09).The researchers found no association of birth weight percentile and strabismus, while GA played a major role in the multivariable association with inclusion of known risk factors such as anisometropia or anisoastigmatism. “Birth weight should always be considered in relation to GA, as children with the same birth weight but one born at term and the other born preterm may have very different outcomes,” they noted. “Our study suggests that it is neonatal immaturity that plays a decisive role in the development of strabismus, rather than adverse fetal growth indicated by a low birth weight percentile.”Click here for the journal source. Fieß A, Gißler S, Hartmann A, et al. Prevalence of strabismus, nystagmus and risk factors in children and adolescents born preterm with and without retinopathy of prematurity: results from the Gutenberg Prematurity Study Young. Br J Ophthalmol. October 9, 2025. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.