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Racial Variation in Retinopathy of Prematurity

Racial Variation in Retinopathy of Prematurity Abstract Objectives: To determine and compare the incidence of severe, vision-threatening retinopathy of prematurity (ROP) in black and white low-birth-weight infants. Design: Prospective cohort study. Setting: Seventy neonatal intensive care units in 23 US participating centers in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity. Patients: A total of 4099 premature infants weighing less than 1251 g at birth were enrolled to evaluate the natural history of ROP. This 'Natural History' cohort included 2158 white infants and 1584 black infants who were followed up prospectively according to a Natural History protocol. Main Outcome Measures: Incidence and severity of acute ROP. Results: While ROP occurred with similar frequency in all racial subgroups, severe ROP was less common in black infants. One hundred sixty (7.4%) of 2158 white infants reached threshold ROP (defined as at least 5 contiguous or 8 cumulative clock-hours of stage 3 retinopathy in zone 1 or zone 2 in the presence of "plus disease" [dilation and tortuosity of the posterior pole blood vessels]), but only 51(3.2%) of 1584 black infants progressed to threshold ROP. Using multiple logistic regression analysis, race emerged as a highly significant factor (P<.001) in the development of threshold disease, even when birth weight, gestational age status at delivery, sex, multiple births, and transport status were considered. Conclusions: Severe, vision-threatening ROP occurs with greater frequency in low-birth-weight white infants than in low-birth-weight black infants who are seemingly at equivalent risk. The reason for this disparity is unknown. We speculate that differences in retinal pigmentation may confer relative protection against free radical-mediated phototoxic injury in black infants. References 1. Palmer EA, Flynn JT, Hardy RJ, et al.. Incidence and early course of retinopathy of prematurity . Ophthalmology . 1991;98:1628-1640.Crossref 2. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results . Arch Ophthalmol . 1988;106:471-479.Crossref 3. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: three-month outcome . Arch Ophthalmol . 1990;108:195-204.Crossref 4. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: one-year outcome: structure and function . Arch Ophthalmol . 1990;108:1408-1416.Crossref 5. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: 3 ½-year outcome: structure and function . Arch Ophthalmol . 1993;111:339-344.Crossref 6. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: Snellen acuity and structural outcome at 5 ½ years after randomization . Arch Ophthalmol . 1996;114:417-424.Crossref 7. Committee forthe Classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity . Arch Ophthalmol . 1984;102:1130-1134.Crossref 8. Shaffer DB, Palmer EA, Plotsky DF, Metz HS, Flynn JT, Tung B. Prognostic factors in the natural course of retinopathy of prematurity . Ophthalmology . 1993;100:230-237.Crossref 9. Koops BL, Morgan LJ, Battaglia FC. Neonatal mortality risk in relation to birth weight and gestational age: update . J Pediatr . 1982;101:969-977.Crossref 10. Zacharias L. Retrolental fibroplasia: a survey . Am J Opthalmol . 1952;35:1426-1454. 11. Ng YK, Shaw DE, Fielder AR, Levene Ml. Child health: epidemiology of retinopathy of prematurity . Lancet . 1988;2:1235-1238.Crossref 12. Distefano G, Tina LG, Romeo MG, et al Epidemiologici e fisiopatologici sulla retinopatia del prematuro: contributo casistico personale . Pediatr Med Chir . 1993;15:371-376. 13. Kivlin JD, Biglan AW, Gordon RA, et al, for the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Cooperative Group.. Early retinal vessel development and iris vessel dilatation as factors in retinopathy of prematurity . Arch Ophthalmol . 1996;114:150-154.Crossref 14. Freeman MG, Graves WL, Thompson RL. Indigent negro and caucasian birth weight-gestational age tables . Pediatrics . 1970;46:9-15. 15. Alexander GR, Tompkins ME, Altekruse JM, Hornung CA. Racial differences in the relation of birth weight and gestational age to neonatal mortality . Public Health Rep . 1985;100:539-547. 16. Shiono PH, Klebanoff MA. Ethnic differences in preterm and very preterm delivery . Am J Public Health . 1986;76:1317-1321.Crossref 17. Kleinman JC, Kessel SS. Racial differences in low birth weight: trends and risk factors . N Engl J Med . 1987;317:749-753.Crossref 18. Phelps DL, Brown DR, Tung B, et al. Survival rates of 6676 neonates with birth weights of 1250 grams or less . Pediatrics . 1991;87:7-17. 19. Rapp LM, Williams TP. The role of ocular pigmentation in protecting against retinal light damage . Vision Res . 1980;20:1127-1131.Crossref 20. Anderson RE, Kretzer FL, Rapp LM. Free radicals and ocular disease . In: Armstrong D, ed. Free Radicals in Diagnostic Medicine . New York, NY: Plenum Press; 1994:73-86. 21. Monos T, Rosen SD, Karplus M, Yassur, Y. Fundus pigmentation in retinopathy of prematurity . Pediatrics . 1996;97:343-348. 22. Arnold RW, Kesler K, Avila E. Susceptitility to retinopathy of prematurity in Alaskan natives . J Pediatr Ophthalmol Strabismus . 1994;31:192-194. 23. Hepner WR, Krause AC, Davis ME. Retrolental fibroplasia and light . Pediatrics . 1949;3:824-828. 24. Locke JC, Reese AB. Retrolental fibroplasia: the negative role of light, mydriatics, and the ophthalmoscopic examination in its etiology . Arch Ophthalmol . 1952;48:44-47.Crossref 25. Glass P, Avery GB, Subramanian KNS, Keys MP, Sostek AM, Friendly DS. Effect of bright light in the hospital nursery on the incidence of retinopathy of prematurity . N Engl J Med . 1985;313:401-404.Crossref 26. Ackerman B, Sherwonit E, Williams J. Reduced incidental light exposure: effect on the development of retinopathy of prematurity in low birth weight infants . Pediatrics . 1989;83:958-962. 27. Seiberth V, Linderkamp O, Knorz MC, Liesenhoff H. A controlled clinical trial of light and retinopathy of prematurity . Am J Ophthalmol . 1994;118:492-495. 28. Ricci B, Lepore D, lossa M, Santo A, D'Urso M, Maggiano N. Effect of light on oxygen-induced retinopathy in the rat model . Doc Ophthalmol . 1990;74:287-301.Crossref 29. Kremer I, Levitt A, Goldberg G, Wilunsky E, Merlob P, Nissenkorn I. The effect of light on oxygen-induced vasoproliferative retinopathy in newborn kittens . Invest Ophthalmol Vis Sci . 1992;33:1595-1598. 30. Wesolowski E, Smith LEH. Effect of light on oxygen-induced retinopathy in the mouse . Invest Ophthalmol Vis Sci . 1994;35:112-119. 31. Robinson J, Moseley MJ, Thompson JR, Fielder AR. Eyelid opening in preterm neonates . Arch Dis Child . 1989;64:943-948.Crossref 32. Isenberg SJ, Molarte A, Vazquez M. The fixed and dilated pupils of premature neonates . Am J Ophthalmol . 1990;110:168-171. 33. Robinson J, Fielder AR. Pupillary diameter and reaction to light in preterm neonates . Arch Dis Child . 1990;65:35-38.Crossref 34. Wegman ME. Annual summary of vital statistics-1992 . Pediatrics . 1993;92:743-754. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

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American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1997.01100150606005
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Abstract

Abstract Objectives: To determine and compare the incidence of severe, vision-threatening retinopathy of prematurity (ROP) in black and white low-birth-weight infants. Design: Prospective cohort study. Setting: Seventy neonatal intensive care units in 23 US participating centers in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity. Patients: A total of 4099 premature infants weighing less than 1251 g at birth were enrolled to evaluate the natural history of ROP. This 'Natural History' cohort included 2158 white infants and 1584 black infants who were followed up prospectively according to a Natural History protocol. Main Outcome Measures: Incidence and severity of acute ROP. Results: While ROP occurred with similar frequency in all racial subgroups, severe ROP was less common in black infants. One hundred sixty (7.4%) of 2158 white infants reached threshold ROP (defined as at least 5 contiguous or 8 cumulative clock-hours of stage 3 retinopathy in zone 1 or zone 2 in the presence of "plus disease" [dilation and tortuosity of the posterior pole blood vessels]), but only 51(3.2%) of 1584 black infants progressed to threshold ROP. Using multiple logistic regression analysis, race emerged as a highly significant factor (P<.001) in the development of threshold disease, even when birth weight, gestational age status at delivery, sex, multiple births, and transport status were considered. Conclusions: Severe, vision-threatening ROP occurs with greater frequency in low-birth-weight white infants than in low-birth-weight black infants who are seemingly at equivalent risk. The reason for this disparity is unknown. We speculate that differences in retinal pigmentation may confer relative protection against free radical-mediated phototoxic injury in black infants. References 1. Palmer EA, Flynn JT, Hardy RJ, et al.. Incidence and early course of retinopathy of prematurity . Ophthalmology . 1991;98:1628-1640.Crossref 2. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: preliminary results . Arch Ophthalmol . 1988;106:471-479.Crossref 3. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: three-month outcome . Arch Ophthalmol . 1990;108:195-204.Crossref 4. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: one-year outcome: structure and function . Arch Ophthalmol . 1990;108:1408-1416.Crossref 5. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: 3 ½-year outcome: structure and function . Arch Ophthalmol . 1993;111:339-344.Crossref 6. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity: Snellen acuity and structural outcome at 5 ½ years after randomization . Arch Ophthalmol . 1996;114:417-424.Crossref 7. Committee forthe Classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity . Arch Ophthalmol . 1984;102:1130-1134.Crossref 8. Shaffer DB, Palmer EA, Plotsky DF, Metz HS, Flynn JT, Tung B. Prognostic factors in the natural course of retinopathy of prematurity . Ophthalmology . 1993;100:230-237.Crossref 9. Koops BL, Morgan LJ, Battaglia FC. Neonatal mortality risk in relation to birth weight and gestational age: update . J Pediatr . 1982;101:969-977.Crossref 10. Zacharias L. Retrolental fibroplasia: a survey . Am J Opthalmol . 1952;35:1426-1454. 11. Ng YK, Shaw DE, Fielder AR, Levene Ml. Child health: epidemiology of retinopathy of prematurity . Lancet . 1988;2:1235-1238.Crossref 12. Distefano G, Tina LG, Romeo MG, et al Epidemiologici e fisiopatologici sulla retinopatia del prematuro: contributo casistico personale . Pediatr Med Chir . 1993;15:371-376. 13. Kivlin JD, Biglan AW, Gordon RA, et al, for the Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) Cooperative Group.. Early retinal vessel development and iris vessel dilatation as factors in retinopathy of prematurity . Arch Ophthalmol . 1996;114:150-154.Crossref 14. Freeman MG, Graves WL, Thompson RL. Indigent negro and caucasian birth weight-gestational age tables . Pediatrics . 1970;46:9-15. 15. Alexander GR, Tompkins ME, Altekruse JM, Hornung CA. Racial differences in the relation of birth weight and gestational age to neonatal mortality . Public Health Rep . 1985;100:539-547. 16. Shiono PH, Klebanoff MA. Ethnic differences in preterm and very preterm delivery . Am J Public Health . 1986;76:1317-1321.Crossref 17. Kleinman JC, Kessel SS. Racial differences in low birth weight: trends and risk factors . N Engl J Med . 1987;317:749-753.Crossref 18. Phelps DL, Brown DR, Tung B, et al. Survival rates of 6676 neonates with birth weights of 1250 grams or less . Pediatrics . 1991;87:7-17. 19. Rapp LM, Williams TP. The role of ocular pigmentation in protecting against retinal light damage . Vision Res . 1980;20:1127-1131.Crossref 20. Anderson RE, Kretzer FL, Rapp LM. Free radicals and ocular disease . In: Armstrong D, ed. Free Radicals in Diagnostic Medicine . New York, NY: Plenum Press; 1994:73-86. 21. Monos T, Rosen SD, Karplus M, Yassur, Y. Fundus pigmentation in retinopathy of prematurity . Pediatrics . 1996;97:343-348. 22. Arnold RW, Kesler K, Avila E. Susceptitility to retinopathy of prematurity in Alaskan natives . J Pediatr Ophthalmol Strabismus . 1994;31:192-194. 23. Hepner WR, Krause AC, Davis ME. Retrolental fibroplasia and light . Pediatrics . 1949;3:824-828. 24. Locke JC, Reese AB. Retrolental fibroplasia: the negative role of light, mydriatics, and the ophthalmoscopic examination in its etiology . Arch Ophthalmol . 1952;48:44-47.Crossref 25. Glass P, Avery GB, Subramanian KNS, Keys MP, Sostek AM, Friendly DS. Effect of bright light in the hospital nursery on the incidence of retinopathy of prematurity . N Engl J Med . 1985;313:401-404.Crossref 26. Ackerman B, Sherwonit E, Williams J. Reduced incidental light exposure: effect on the development of retinopathy of prematurity in low birth weight infants . Pediatrics . 1989;83:958-962. 27. Seiberth V, Linderkamp O, Knorz MC, Liesenhoff H. A controlled clinical trial of light and retinopathy of prematurity . Am J Ophthalmol . 1994;118:492-495. 28. Ricci B, Lepore D, lossa M, Santo A, D'Urso M, Maggiano N. Effect of light on oxygen-induced retinopathy in the rat model . Doc Ophthalmol . 1990;74:287-301.Crossref 29. Kremer I, Levitt A, Goldberg G, Wilunsky E, Merlob P, Nissenkorn I. The effect of light on oxygen-induced vasoproliferative retinopathy in newborn kittens . Invest Ophthalmol Vis Sci . 1992;33:1595-1598. 30. Wesolowski E, Smith LEH. Effect of light on oxygen-induced retinopathy in the mouse . Invest Ophthalmol Vis Sci . 1994;35:112-119. 31. Robinson J, Moseley MJ, Thompson JR, Fielder AR. Eyelid opening in preterm neonates . Arch Dis Child . 1989;64:943-948.Crossref 32. Isenberg SJ, Molarte A, Vazquez M. The fixed and dilated pupils of premature neonates . Am J Ophthalmol . 1990;110:168-171. 33. Robinson J, Fielder AR. Pupillary diameter and reaction to light in preterm neonates . Arch Dis Child . 1990;65:35-38.Crossref 34. Wegman ME. Annual summary of vital statistics-1992 . Pediatrics . 1993;92:743-754.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: May 1, 1997

References