Vision-Related Quality of Life in Malaysian Children with Threshold and Pre-Threshold Retinopathy of Prematurity

Purpose: The 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 pre-threshold ROP on VRQoL in Malaysian children.

Methods: Multicenter prospective cross-sectional study conducted in three tertiary hospitals in 2018 to 2019. Children less than seven years old with previous ROP diagnosis were recruited and divided into threshold, high-risk and low-risk pre-threshold subgroups. Patients with systemic comorbidities that affected vision or daily activities were excluded. A parent/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.

Results: Eight were categorized with threshold ROP, 16 with high-risk pre-threshold ROP, and 26 with low-risk pre-threshold ROP. 50 age-matched controls were also included. Mean visual acuity in logMAR was 0.46 in the threshold, 0.08 in high risk pre-threshold and 0.01 in low-risk pre-threshold subgroups. Threshold ROP was associated with myopia and strabismus, and associated with poor visual acuity compared to pre-threshold 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 pre-threshold subgroups, with lowest subscale scores on general vision and general health. There was significant association between gestational age, visual acuity of the better eye and family income and VRQoL (p<0.05).

Conclusion: ROP 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.